Background Readmission within 30 days of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNF), making post-acute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery. Materials and Methods We utilize the CMS Chronic Conditions Warehouse, a longitudinal 5% national random sample of Medicare beneficiaries to study 30-day readmission or death after discharge to SNF following abdominal aortic aneurysm (AAA) repair or lower extremity revascularization (LER) from 2005–2009. Descriptive statistics and logistic regression with LASSO (Least Adaptive Shrinkage and Selection Operator) were used for analysis. Results 2197 patients underwent an AAA procedure or LER at 686 hospitals and discharged to 1714 SNF. 800 (36%) were readmitted or had died at 30 days. In adjusted analysis, predictors of readmission or death at 30 days included SNF for-profit status (OR=1.2; p=0.032), number of hospitalizations in the previous year (OR=1.06; p=0.011), number of comorbidities (OR=1.06; p=0.004), emergent procedure (OR=1.69; p<0.001), renal complication (OR=1.38; p=0.003), respiratory complication (OR=1.45; p<0.001), thromboembolic complication (OR=1.57; p=0.019), and wound complication (OR=0.70; p=0.017). Discussion Patients discharged to SNF following vascular surgery have exceptionally high rates of readmission or death at 30 days. Many factors predicting readmission or death potentially modify decision-making around discharge, making early detection, discharge planning, and matching patient needs to SNF capabilities essential to improving outcomes.

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Questions: Spatial characteristics of ecotones can affect ecotone function and define their role in ecological systems. Identifying ecotone location is necessary to quantify the relationship between spatial characteristics and function, yet there is no standard approach, particularly for compositionally complex ecotones where binary classification for the two adjacent systems is difficult to assign. We tested a new approach for identifying ecotone location based on the co-occurrence property, which recognizes ecotones as areas where species from adjacent systems co-occur. We assessed whether the approach can objectively identify the location of the Tension Zone in Wisconsin.

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