Causes and implications of readmission after abdominal aortic aneurysm repair

David Yu Greenblatt, Caprice C. Greenberg, Amy J.H. Kind, Jeffrey A. Havlena, Matthew Mell, Matthew T. Nelson, Maureen A. Smith, K. Craig Kent

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

OBJECTIVE: To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair. BACKGROUND DATA: Centers for Medicare & Medicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed. METHODS: We analyzed elective AAA repairs over a 2-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries. RESULTS: A total of 2481 patients underwent AAA repair-1502 endovascular aneurysm repair (EVAR) and 979 open aneurysm repair. Thirty-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). Although wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed-eg, bowel obstruction was common after open repair, and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors, including serious complications leading to prolonged length of stay and discharge destination other than home, had a profound influence on the probability of readmission. The 1-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (P < 0.001). CONCLUSIONS: Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.

Original languageEnglish (US)
Pages (from-to)595-605
Number of pages11
JournalAnnals of Surgery
Volume256
Issue number4
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Abdominal Aortic Aneurysm
Aneurysm
Medicare
Comorbidity
Vascular Surgical Procedures
Medicaid
Length of Stay
Multivariate Analysis
Transplants
Costs and Cost Analysis
Survival
Mortality
Wounds and Injuries
Population

Keywords

  • AAA repair
  • abdominal aortic aneurysm repair
  • CMS
  • healthcare reform
  • Medicare
  • readmission
  • rehospitalization
  • surgical outcomes
  • vascular surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Greenblatt, D. Y., Greenberg, C. C., Kind, A. J. H., Havlena, J. A., Mell, M., Nelson, M. T., ... Kent, K. C. (2012). Causes and implications of readmission after abdominal aortic aneurysm repair. Annals of Surgery, 256(4), 595-605. https://doi.org/10.1097/SLA.0b013e31826b4bfe

Causes and implications of readmission after abdominal aortic aneurysm repair. / Greenblatt, David Yu; Greenberg, Caprice C.; Kind, Amy J.H.; Havlena, Jeffrey A.; Mell, Matthew; Nelson, Matthew T.; Smith, Maureen A.; Kent, K. Craig.

In: Annals of Surgery, Vol. 256, No. 4, 01.10.2012, p. 595-605.

Research output: Contribution to journalArticle

Greenblatt, DY, Greenberg, CC, Kind, AJH, Havlena, JA, Mell, M, Nelson, MT, Smith, MA & Kent, KC 2012, 'Causes and implications of readmission after abdominal aortic aneurysm repair', Annals of Surgery, vol. 256, no. 4, pp. 595-605. https://doi.org/10.1097/SLA.0b013e31826b4bfe
Greenblatt DY, Greenberg CC, Kind AJH, Havlena JA, Mell M, Nelson MT et al. Causes and implications of readmission after abdominal aortic aneurysm repair. Annals of Surgery. 2012 Oct 1;256(4):595-605. https://doi.org/10.1097/SLA.0b013e31826b4bfe
Greenblatt, David Yu ; Greenberg, Caprice C. ; Kind, Amy J.H. ; Havlena, Jeffrey A. ; Mell, Matthew ; Nelson, Matthew T. ; Smith, Maureen A. ; Kent, K. Craig. / Causes and implications of readmission after abdominal aortic aneurysm repair. In: Annals of Surgery. 2012 ; Vol. 256, No. 4. pp. 595-605.
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abstract = "OBJECTIVE: To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair. BACKGROUND DATA: Centers for Medicare & Medicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed. METHODS: We analyzed elective AAA repairs over a 2-year period from the CMS Chronic Conditions Warehouse, a 5{\%} national sample of Medicare beneficiaries. RESULTS: A total of 2481 patients underwent AAA repair-1502 endovascular aneurysm repair (EVAR) and 979 open aneurysm repair. Thirty-day readmission rates were equivalent for EVAR (13.3{\%}) and open repair (12.8{\%}). Although wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed-eg, bowel obstruction was common after open repair, and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors, including serious complications leading to prolonged length of stay and discharge destination other than home, had a profound influence on the probability of readmission. The 1-year mortality in readmitted patients was 23.4{\%} versus 4.5{\%} in those not readmitted (P < 0.001). CONCLUSIONS: Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.",
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