Reasons for readmission after carotid endarterectomy

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.