A nationwide analysis of 30-day readmissions related to critical limb ischemia

Abstract

Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease. From this group, all patients readmitted with similar diagnosis within 30 days were recorded. Results Of the total 25,111 index hospitalization for critical limb ischemia, 1270 (5%) were readmitted with a primary diagnosis of critical limb ischemia within 30 days. The readmission rate was highest (9.5%) for the group that did not have any intervention (revascularization or major amputation) and was lowest for surgical revascularization and major amputation groups (2.6% and 1.3%, P value <0.001 for all groups). Severity of critical limb ischemia at index admission was associated with a significantly higher rate of 30-day readmission. Critical limb ischemia-related readmission was associated with a higher rate of major amputation (29.6% vs. 16.2%, P<0.001), a lower rate of any revascularization procedure (46% vs. 62.6%, P<0.001), and a higher likelihood of discharge to a skilled nursing facility (43.2% vs. 32.2%, P<0.001) compared to index hospitalization. Conclusions In patients with primary diagnosis of critical limb ischemia, 30-day critical limb ischemia-related readmission rate was affected by initial management strategy and the severity of critical limb ischemia. Readmission was associated with a significantly higher rate of amputation, increased length of stay, and a more frequent discharge to an alternate care facility than index admission and thus may serve as a useful quality of care metric in critical limb ischemia patients.

<p>The burden of critical limb ischemia: a review of recent literature</p>

“…Furthermore, a study by Kolte and colleagues (2017) using the NIS database shows an increasing likelihood of readmission with increasing disease severity 23Table 2CLI readmission ratesPublicationCountry/regionData source (years)Population detailsMethodsReadmission rate ranges (see figure 1 for detail)Reed (2016)70Cleveland, OHCleveland Clinic (2011–2015)CLI patients undergoing endovascular treatmentRetrospective analysis of medical records30-day: 13.9%6-month: 40.5%Jones (2016)71United StatesACS National Surgical Quality Improvement Program (2012–2014)CLI patients undergoing open bypass for rest pain or tissue lossCPT codes to identify cases30-day: 16.5–18.8%Agarwal (2017)29States of CA, FL, and NYState inpatient databases (2009–2013)Patients with a principal diagnosis of CLIICD-9 diagnosis and procedure codes used to identify cases and procedures30-day: 23.6–29.1%6-month: 47.7–59.5%Bodewes (2017)72United StatesACS National Surgical Quality Improvement Program (2012–2014)CLI patients undergoing infrainguinal endovascular treatmentCPT codes to identify cases30-day: 16%Kolte (2017)23United StatesNationwide Readmissions Database (2013–2014)CLI patients undergoing open or endovascular treatmentICD-9 diagnosis and procedure codes used to identify cases and procedures30-day: 14.8–25.0%Martinez (2018)64United StatesNationwide Readmissions Database (2013–2014)CLI patients undergoing revascularization proceduresICD-9 diagnosis and procedure codes used to identify cases and procedures30-day: 19.3%Overall: 40.4%Masoomi (2018)73United StatesNationwide Readmissions Database (2013)CLI patients with/without revascularization proceduresICD-9 diagnosis and proc...…”

Acute kidney injury in patients undergoing endovascular therapy for critical limb ischemia

“…The rise in comorbidity prevalence over the analysis period appears to be a key contributor. In addition, the literature has established that there are an increasing number of endovascular procedures being performed in the United States over the past decade with an “endovascular first” approach advocated by many—particularly for CLI . The procedural complexity has shifted to treating longer lesions, chronic total occlusions, and multilevel disease .…”

“…States over the past decade with an "endovascular first" approach advocated by many-particularly for CLI. 13,18,19 The procedural complexity has shifted to treating longer lesions, chronic total occlusions, and multilevel disease. 20 The impact of these technical changes on contrast volume use, AKI risk, and renal outcomes remains uncertain.…”

Nationwide study of six-month readmissions in critical limb ischemia: Predictors and impact of revascularization strategies

“…Thirty-day readmission is affected by several factors, including initial CLI severity at presentation (rest pain, ulcer or gangrene) and initial revascularization strategy. 16 In a chronic disease such as CLI, 30-day readmissions may not adequately reflect the disease-related and management strategy related effects and longer-term readmissions may be more revealing. There is a paucity of nationwide data on readmissions in CLI beyond six months.…”