Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Melvin, Joseph C.; Smith, Jamie; Kruse, Robin L.; Vogel, Todd R.

doi:10.1089/sur.2016.234

Cited by 19 publications

(17 citation statements)

References 27 publications

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“…Vascular surgery, specifically, has been linked with a readmission rate of almost 24%, much higher than the overall readmission rate for other types of surgery, when all diagnoses and procedures are considered. [8][9][10] Resources have been directed to identifying and potentially mitigating preventable readmission, which in vascular surgery has been demonstrated to be a substantial cost-burden to hospital systems when compared with other types of surgery. 11 Complications such as an unplanned return to the operating room are routinely captured in administrative datasets such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and has been considered a potentially preventable postoperative complication, which has been previously described as a risk-factor for readmission.…”

Section: Introductionmentioning

confidence: 99%

Impact of Patient Safety Indicators on readmission after abdominal aortic surgery

Bath

Dombrovskiy

Vogel

2018

Journal of Vascular Nursing

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Objective: Patient safety is a critical component of health care quality and measures created by the Agency for Healthcare Research and Quality (AHRQ) to identify hospitalizations with potentially preventable adverse events. This analysis evaluated whether Patient Safety Indicator (PSI) events following open (OSR) or endovascular (EVAR) repair of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. Methods: Patients undergoing elective repair of non-ruptured AAA from 2009 to 2012 were selected in the Medicare Provider Analysis and Review (MedPAR) files using the ICD-9-CM codes. To identify PSI events, we utilized the AHRQ Patient Safety Indicator ICD-9-CM numerator codes. Chi-square test, multivariable logistic regression analysis, non-parametric Wilcoxon rank sum test, and Kaplan-Meier survival analysis were used for statistics. Results: 66,923 patients undergoing elective AAA repair were evaluated: 9,315 with OSR and 57,608 with EVAR. The most frequent PSI events after OSR vs. EVAR were: postoperative respiratory failure (PSI 11; 17.7% vs. 1.8%, p<.0001); perioperative hemorrhage/hematoma (PSI 9; 3.6% vs. 2.6%, p<.0001); postoperative sepsis (PSI 13; 3.5% vs. 0.4%, p<.0001); accidental puncture or laceration (PSI 15; 2.1% vs. 0.6%, p<.0001); and postoperative acute kidney injury requiring dialysis (PSI 10; 1.4% vs. 0.2%, p<.0001). The overall 30-day readmission rate was 10.5%. The occurrence of any PSI event overall significantly increased 30-day readmission compared with no event cases (OR =1.71; 95% CI 1.57-1.86). Likelihood of 30-day readmission was greater for postoperative acute kidney injury requiring dialysis (OR=1.66; 95% CI 1.28-2.15), postoperative respiratory failure (OR=1.36; 95% CI 1.22-1.52), perioperative hemorrhage (OR=1.34; 95% CI 1.18-1.52), and postoperative pressure ulcer (OR=CI, 1.68-3.05). Occurrence of any PSI event was associated with an increased total hospital and ICU (Intensive Care Unit) length of stay and total hospital charges (all p<0.001).

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Section: Introductionmentioning

confidence: 99%

Impact of Patient Safety Indicators on readmission after abdominal aortic surgery

Bath

Dombrovskiy

Vogel

2018

Journal of Vascular Nursing

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“…In the proposed classification focusing on IC only, a grading was created based on their clinical consequences. After clustering severe IC grades 2-6, it was demonstrated that patient-related factors such as previous vascular surgery [11], anemia [12], and procedure-related factors such as the extent of the surgery [13] indeed had an impact on IC grade. Although a floor effect, which generally indicates the coarseness of a classification system, was observed in the system, it could be expected that the majority of these patients would not suffer from IC.…”

Section: Discussionmentioning

confidence: 99%

Proposed Classification of Incision Complications: Analysis of a Prospective Study on Elective Open Lower-Limb Revascularization

Hasselmann

Björk

Svensson‐Björk

et al. 2020

Surgical Infections

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Background: Incision complications (IC) have a significant impact on procedure-related morbidity after lowerlimb revascularization. One of the most studied IC is surgical site infection (SSI). Reporting these complications in a uniform way is crucial to evaluate treatment approaches. The aim of this study was to propose a comprehensive classification of IC and apply it to compare SSI with other IC in a trial on elective open lowerlimb revascularization procedures. Methods: Two hundred twenty-three eligible patients undergoing elective unilateral inguinal and infra-inguinal arterial vascular surgery were extracted from a randomized controlled trial on incisional negative-pressure wound therapy (NPWT) on inguinal vascular surgical incisions. The IC were classified by grades of severity (grade 0-6) that focused on IC-related consequences such as out-patient treatment (grade 1), prolonged inpatient treatment (grade 2), re-admission (grade 3), and re-operation (grade ‡4). An SSI was defined by the ASEPSIS score criteria. Results: An SSI was diagnosed in 63 patients (28.3%). Thirty-five of 160 patients (21.8%) not suffering from SSI underwent IC treatment. Treatment for IC was recorded for 25/144 patients (17.4%) with satisfactory site healing as judged by the ASEPSIS score. The median incision-related in-hospital stay in those with SSI (n = 79) and disturbed healing (n = 16) according to the ASEPSIS score was 13 days in both groups (p = 0.53). Five patients had peri-vascular SSI (IC grade 4 n = 4; grade 5 n = 1). The proposed classification of IC and the ASEPSIS score correlated highly (r = 0.77; p < 0.001). Inter-rater reliability for IC grading was substantial for three investigators with different levels of experience (k = 0.81, 0.71, and 0.70). Conclusions: The proposed incision classification suggests a comparable clinical significance of vascular IC in terms of IC-related in-patient stay, whether there was a surgical site infection or not. This classification system requires external validation.

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“…Subgroup analyses stratified by age and gender were performed, and adjusted for calendar period, physical illness, substance abuse, and premorbid use of antipsychotics. As previous studies reported positive association between former infection and the risk of infections , all analyses were adjusted for history of hospital contact with infection prior to the study start (stratification) (Melvin et al 2017) ; (Abad et al 2017) (Hamilton et al 2013).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of major infections in schizophrenia. A nationwide Danish register study

Pankiewicz-Dulacz

Chen

Stenager

2019

Journal of Psychosomatic Research

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Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Cited by 19 publications

References 27 publications

Impact of Patient Safety Indicators on readmission after abdominal aortic surgery

Impact of Patient Safety Indicators on readmission after abdominal aortic surgery

Proposed Classification of Incision Complications: Analysis of a Prospective Study on Elective Open Lower-Limb Revascularization

Risk factors of major infections in schizophrenia. A nationwide Danish register study

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