Low rehospitalization rate for vascular surgery patients

• Published in: Journal of vascular surgery 2011-09, Vol.54 (3), p.767-772
• Main Authors: Jackson, Benjamin M., MD, Nathan, Derek P., MD, Doctor, Lynne, MD, Wang, Grace J., MD, Woo, Edward Y., MD, Fairman, Ronald M., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chi-Square Distribution; Diabetes Complications; Emergency and intensive care: renal failure. Dialysis management; Female; Hospitals, University - statistics & numerical data; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Pennsylvania; Postoperative Complications - diagnosis; Postoperative Complications - surgery; Prospective Studies; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.03.255

Objectives Reducing rehospitalization rates has been proposed to improve care, reduce costs, and as a pay-for-performance criterion. Recent review of Medicare claims data indicates that vascular surgery patients have among the highest rates of 30-day rehospitalization at 23.9%. Methods We retrospectively examined all live patient discharges (n = 799) from the vascular surgery service at a single university hospital over 12 months. Planned and unplanned 30-day rehospitalizations were distinguished, and predictors of unplanned 30-day rehospitalization were determined. To identify whether patients were readmitted to other hospitals, a prospective study of patient discharges (n = 66) over 1 month was also performed. Results Ninety-five (11.9%) of the 799 patient discharges from the vascular surgery service were rehospitalized within 30 days. Of these, 71 were unplanned; therefore, the unplanned rehospitalization rate was 8.9%. The most common causes of unplanned 30-day rehospitalization were related to wound complications. Diabetes ( P = .039) predicted unplanned 30-day rehospitalization by multivariate analysis. Patients with the diagnosis of critical limb ischemia (14.9%) and patients undergoing open lower extremity revascularization (14.6%) had the highest rates of unplanned 30-day rehospitalization. In the prospective portion of this study, no patient was readmitted to any other hospital. Conclusions Relatively low 30-day rehospitalization was accomplished in vascular surgery patients at a single university hospital. Moreover, planned rehospitalizations accounted for approximately 25% of readmissions in vascular surgery patients. Strategies designed to reduce rehospitalization in diabetics may be warranted.