High readmission rates after revascularization for peripheral arterial disease

1. Of patients with peripheral arterial disease (PAD), 17.6% were readmitted within 30 days after being discharged following peripheral arterial revascularization.

2. After standardizing readmission rates by patient characteristics, researchers found only modest differences in readmission rates between hospitals, suggesting that patient characteristics had a stronger effect on readmission than differences in hospital quality.

Evidence Rating Level: 2 (Good)

Study Rundown: Globally, over 200 million people have PAD. Although revascularization procedures may decrease the necessity for amputation in these individuals, there are high readmission rates in patients who have surgical revascularization. This retrospective cohort study assessed readmission rates in the United States for patients who underwent peripheral arterial revascularization for PAD. Researchers also evaluated if this risk differed between hospitals. Using the 2014 Nationwide Readmissions Database (NRD), researchers found that the 30-day readmission rate (out of 61 969 hospitalizations) for PAD patients who underwent peripheral arterial revascularization was 17.6%. Procedural complications were the most common reason for readmission. After standardizing readmission rates by patient characteristics, researchers found only modest differences in readmission rates between hospitals, suggesting that patient characteristics had a stronger effect on readmission than differences in hospital quality. The authors suggest that future strategies to decrease readmissions should be focused on improving care for high-risk patients after they are discharged.

A strength of the study is the analysis of nearly 62 000 hospitalizations. A limitation of this study is that the competing risks of readmission and death after discharge could not be differentiated. Also, billing codes were used to determine diagnoses and interventions, which may introduce misclassification bias.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Risk factors for readmission after lower extremity procedures for peripheral artery disease

In-Depth [retrospective cohort]: In this study, researchers used data from the 2014 NRD to identify 61 969 hospitalizations linked to either endovascular or surgical peripheral arterial revascularization (based on procedure code) in adults ≥18 years of age who were discharged alive. The authors found that of these patients, 17.6% were readmitted within 30 days for unplanned reasons. Causes of readmission included procedural complications (28.0%), sepsis (8.3%), and diabetes mellitus complications (7.5%). Of 10 924 patients were who readmitted, 11.7% had an amputation of the lower extremity, 8.2% had a subsequent peripheral arterial revascularization, and 1.1% had both. There were 503 (4.6%) deaths during rehospitalization. The median readmission cost was $11 013 (range, $142 to $424 098). The main reasons for readmission were factors related to the procedure or the patient.

Image: PD

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