Risk factors associated with 30-day hospital readmission after carotid endarterectomy

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The current study evaluated all-cause 30-day readmissions after carotid endarterectomy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Patients undergoing carotid endarterectomy were selected from the Cerner Health Facts® database using ICD-9-CM procedure codes from their index admission. Readmission within 30 days of discharge was determined. Chi-square analysis determined characteristics of the index admission (demographics, diagnoses, postoperative medications, and laboratory results) associated with readmission. Multivariate logistic regression models were used to identify characteristics independently associated with readmission. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> In total, 5257 patients undergoing elective carotid endarterectomy were identified. Readmission within 30 days was 3.1%. After multivariable adjustment, readmission was associated with end-stage renal disease (OR: 3.21, 95% CI: 1.01–10.2), hemorrhage or hematoma (OR: 2.34, 95% CI: 1.15–4.77), procedural complications (OR: 3.07, 95% CI: 1.24–7.57), use of bronchodilators (OR: 1.48, 95% CI: 1.03–2.11), increased Charlson index scores (OR: 1.22, 95% CI: 1.08–1.38), and electrolyte abnormalities (hyponatremia &lt; 135 mEq/L (OR: 1.69, 95% CI: 1.07–2.67) and hypokalemia less than 3.7 mEq/L (OR: 2.26, 95% CI: 1.03–4.98)). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Factors associated with readmission following carotid endarterectomy included younger age, increased comorbidity burden, end-stage renal disease, electrolyte disorders, the use of bronchodilators, and complications including bleeding (hemorrhage or hematoma). Of note, in this real-world study, only 40% of the patients received protamine, despite evidence-based literature demonstrating the reduced risk of bleeding complications. As healthcare moves towards quality of care-driven reimbursement, physician modifiable targets such as protamine utilization to reduce bleeding are greatly needed to reduce readmission, and failure to reduce preventable physician-driven complications after carotid interventions may be associated with decreased reimbursement. </jats:p></jats:sec>

Post-Hospital Availability of Instrumental Support May Influence Patients' Readiness for Discharge

“…T o reduce 30-day readmissions, heath systems and hospitals have focused on evaluating patient risk factors such as admission diagnoses and patient demographics (Braet et al, 2021). The 2010 Patient Safety and Affordable Care Act included the Hospital Readmissions Reduction Program, which created a performance and incentive-based health care payment system, including a financial penalty for hospitals that have high patient readmission rates within 30 days of discharge.…”