Reasons for readmission after carotid endarterectomy

Aksharananda Rambachan, Timothy R. Smith, Sujata Saha, Mark K. Eskandari, Bernard Bendok, John Y S Kim

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).

Methods Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients. The primary outcome variable was 30-day unplanned readmission. Multiple logistic regression was used, and we controlled for preoperative demographic variables, comorbidities and clinical characteristics, and postoperative medical and surgical complications.

Results Patients with CEA had a 6.0% unplanned readmission rate. The most common comorbidities in the readmitted patients included hypertension, diabetes, and bleeding disorder. Risk-adjusted multiple regression indicated that preoperative bleeding disorder (odds ratio [OR] 1.62), diabetes (OR 1.46), history of a cerebrovascular accident/stroke (OR 1.46), and increasing age (OR 1.01) were statistically significant predictors for readmission. Postoperatively, surgical-site infection (OR 21.90), myocardial infarction (OR 10.35), sepsis/septic shock (OR 7.79), cerebrovascular accident/stroke (OR 6.58), pneumonia (OR 4.37), and urinary tract infection (OR 3.21) were associated with a greater rate of readmission.

Conclusions Readmission after CEA occurs at a comparatively high rate. Preoperative bleeding disorders, diabetes, cerebrovascular accidents, and age and postoperative surgical-site infection, myocardial infarction, sepsis/septic shock, pneumonia, and cerebrovascular accident were associated with readmission. These findings may help guide the surgical management of patients and prevent costly readmissions.

Original languageEnglish (US)
Pages (from-to)E771-E776
JournalWorld Neurosurgery
Volume82
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Odds Ratio
Stroke
Surgical Wound Infection
Hemorrhage
Septic Shock
Comorbidity
Sepsis
Pneumonia
Myocardial Infarction
Patient Protection and Affordable Care Act
Quality Improvement
Urinary Tract Infections
Multivariate Analysis
Logistic Models
Demography
Hypertension

Keywords

  • Carotid endarterectomy
  • Health policy
  • Hospital readmissions
  • Neurosurgery
  • Vascular surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Rambachan, A., Smith, T. R., Saha, S., Eskandari, M. K., Bendok, B., & Kim, J. Y. S. (2014). Reasons for readmission after carotid endarterectomy. World Neurosurgery, 82(6), E771-E776. https://doi.org/10.1016/j.wneu.2013.08.020

Reasons for readmission after carotid endarterectomy. / Rambachan, Aksharananda; Smith, Timothy R.; Saha, Sujata; Eskandari, Mark K.; Bendok, Bernard; Kim, John Y S.

In: World Neurosurgery, Vol. 82, No. 6, 01.12.2014, p. E771-E776.

Research output: Contribution to journalArticle

Rambachan, A, Smith, TR, Saha, S, Eskandari, MK, Bendok, B & Kim, JYS 2014, 'Reasons for readmission after carotid endarterectomy', World Neurosurgery, vol. 82, no. 6, pp. E771-E776. https://doi.org/10.1016/j.wneu.2013.08.020
Rambachan A, Smith TR, Saha S, Eskandari MK, Bendok B, Kim JYS. Reasons for readmission after carotid endarterectomy. World Neurosurgery. 2014 Dec 1;82(6):E771-E776. https://doi.org/10.1016/j.wneu.2013.08.020
Rambachan, Aksharananda ; Smith, Timothy R. ; Saha, Sujata ; Eskandari, Mark K. ; Bendok, Bernard ; Kim, John Y S. / Reasons for readmission after carotid endarterectomy. In: World Neurosurgery. 2014 ; Vol. 82, No. 6. pp. E771-E776.
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N2 - Objective With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).Methods Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients. The primary outcome variable was 30-day unplanned readmission. Multiple logistic regression was used, and we controlled for preoperative demographic variables, comorbidities and clinical characteristics, and postoperative medical and surgical complications.Results Patients with CEA had a 6.0% unplanned readmission rate. The most common comorbidities in the readmitted patients included hypertension, diabetes, and bleeding disorder. Risk-adjusted multiple regression indicated that preoperative bleeding disorder (odds ratio [OR] 1.62), diabetes (OR 1.46), history of a cerebrovascular accident/stroke (OR 1.46), and increasing age (OR 1.01) were statistically significant predictors for readmission. Postoperatively, surgical-site infection (OR 21.90), myocardial infarction (OR 10.35), sepsis/septic shock (OR 7.79), cerebrovascular accident/stroke (OR 6.58), pneumonia (OR 4.37), and urinary tract infection (OR 3.21) were associated with a greater rate of readmission.Conclusions Readmission after CEA occurs at a comparatively high rate. Preoperative bleeding disorders, diabetes, cerebrovascular accidents, and age and postoperative surgical-site infection, myocardial infarction, sepsis/septic shock, pneumonia, and cerebrovascular accident were associated with readmission. These findings may help guide the surgical management of patients and prevent costly readmissions.

AB - Objective With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).Methods Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients. The primary outcome variable was 30-day unplanned readmission. Multiple logistic regression was used, and we controlled for preoperative demographic variables, comorbidities and clinical characteristics, and postoperative medical and surgical complications.Results Patients with CEA had a 6.0% unplanned readmission rate. The most common comorbidities in the readmitted patients included hypertension, diabetes, and bleeding disorder. Risk-adjusted multiple regression indicated that preoperative bleeding disorder (odds ratio [OR] 1.62), diabetes (OR 1.46), history of a cerebrovascular accident/stroke (OR 1.46), and increasing age (OR 1.01) were statistically significant predictors for readmission. Postoperatively, surgical-site infection (OR 21.90), myocardial infarction (OR 10.35), sepsis/septic shock (OR 7.79), cerebrovascular accident/stroke (OR 6.58), pneumonia (OR 4.37), and urinary tract infection (OR 3.21) were associated with a greater rate of readmission.Conclusions Readmission after CEA occurs at a comparatively high rate. Preoperative bleeding disorders, diabetes, cerebrovascular accidents, and age and postoperative surgical-site infection, myocardial infarction, sepsis/septic shock, pneumonia, and cerebrovascular accident were associated with readmission. These findings may help guide the surgical management of patients and prevent costly readmissions.

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