Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program

Abstract

BACKGROUND Postoperative readmission, recently identified as a marker of hospital quality in the Affordable Care Act, is associated with increased morbidity, mortality and healthcare costs, yet data on readmission following lower extremity amputation is limited. We evaluated risk factors for readmission and post-discharge adverse events following lower extremity amputation in the ACS-NSQIP. STUDY DESIGN All patients undergoing transmetatarsal (TMA), below-knee (BKA) or above-knee amputation (AKA) in the 2011 – 2012 NSQIP were identified. Independent pre-discharge predictors of 30-day readmission were determined using multivariable logistic regression. Readmission indication and re-interventions, available in the 2012 NSQIP only, were also evaluated. RESULTS We identified 5,732 patients undergoing amputation (TMA: 12%; BKA: 51%; AKA: 37%). Readmission rate was 18%. Post-discharge mortality rate was 5% (TMA: 2%; BKA: 3%; AKA: 8%; p<.001). Overall complication rate was 43% (In-hospital: 32%; Post-discharge: 11%). Reoperation was for wound related complication or additional amputation in 79% of cases. Independent predictors of readmission included chronic nursing home residence (OR: 1.3; 95% CI: 1.0–1.7), non-elective surgery (OR: 1.4; 95% CI: 1.1–1.7), prior revascularization/amputation (OR: 1.4; 95% CI: 1.1–1.7), preoperative congestive heart failure (OR: 1.7; 95% CI: 1.2–2.4), and preoperative dialysis (OR: 1.5; 95% CI: 1.2–1.9). Guillotine amputation (OR: .6; 95%CI: .4–.9) and non-home discharge (OR: .7; 95%CI: .6–1.0) were protective of readmission. Wound related complications accounted for 49% of readmissions. CONCLUSIONS Post discharge morbidity, mortality and readmission are common following lower extremity amputation. Closer follow up of high risk patients, optimization of medical comorbidities and aggressive management of wound infection may play a role in decreasing readmission and post discharge adverse events.

Utilization of Acute Care among Patients with ESRD Discharged Home from Skilled Nursing Facilities

“…These results highlight the importance of understanding modifiable risk factors of acute care use after SNF discharge in older adults with ESRD in order to identify interventions to curb acute care use in this population. Among members of this cohort, soft tissue infections at the time of SNF admission were strongly associated with acute care use within 30 days of SNF discharge and support the potential importance of efforts to optimize wound management among patients transitioning from SNF to home (21). Although none of the SNF organizational characteristics were associated with early acute care use in our study, prior studies have suggested that direct care hours per patient are associated with resident outcomes (22).…”

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

“…Several authors have reported rates of readmission after individual vascular procedures, such as abdominal aortic aneurysm repair (8%-54%), [14][15][16] amputation (9%-18%), [17][18][19] and lower extremity bypass (12%-49%). 8,9,11,20,21 However, there are conflicting reports regarding readmission rates and reasons.…”

Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

“…Though the patient population in this study was comparable in size to others in the literature, the ACS-NSQIP database contained relatively few ATR compared to other conditions it has been used to investigate [22][23][24].…”