Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

Siracuse, Jeffrey J.; Shah, Nishant K.; Peacock, Matthew; Tahhan, Georges; Kalish, Jeffrey; Rybin, Denis; Eslami, Mohammad H.; Farber, Alik

doi:10.1016/j.jvs.2016.11.023

Cited by 25 publications

(17 citation statements)

References 24 publications

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“…1,2 A number of studies have demonstrated that patients undergoing vascular surgery procedures have 30-day readmission rates as high as 28.5%. [2][3][4][5][6] In particular, patients with Medicare undergoing vascular surgery have a 30-day readmission rate of 23.9%, which is highest among other surgical specialties. 2 The Centers for Medicare & Medicaid Services introduced the Hospital Readmissions Reduction Program in 2012 to reduce readmissions by penalizing centers with higher than expected readmission rates by withholding up to 1% of Medicare reimbursement.…”

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confidence: 99%

Readmissions after thoracic endovascular aortic repair

Kalesan

Cheng

Farber

et al. 2018

Journal of Vascular Surgery

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A large portion of patients treated with TEVAR were readmitted most commonly for heart-related reasons at 30 days and aorta-related reasons at 90 and 180 days. TEVAR performed to treat initial aortic rupture and greater DRG severity grade were independently associated with an index readmission at 30, 90, and 180 days. Urgent/emergent TEVAR was independently associated with an index readmission at 90 and 180 days. These factors are important to consider in using readmissions as a quality measure.

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confidence: 99%

Readmissions after thoracic endovascular aortic repair

Kalesan

Cheng

Farber

et al. 2018

Journal of Vascular Surgery

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“…6,7 Specifically, vascular surgery patients are known to have high postoperative readmission rates, regardless of the procedure. [8][9][10][11][12][13][14][15][16][17][18][19] This circumstance is particularly true for patients undergoing lower extremity infrainguinal bypass (LEB). [10][11][12][13][14][15] Readmission data identified in previous studies only considered postoperative readmission at 30 days and have been high, ranging from 14% to 24%.…”

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confidence: 99%

Short- and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected

Krafcik

Komshian

et al. 2017

Journal of Vascular Surgery

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Short- and long-term readmission rates in a safety net setting are high. The 30-day rates in this study are higher than historically reported. This data sets baseline rates for 90-day and 1-year readmission for future analyses. Although the majority of short-term readmissions are related to the index procedure, long-term readmission rates are more frequently related to systemic comorbidities. Targeted patient interventions aimed at preventing the most common reasons for readmission may improve readmission rates, particularly among patients with nonprivate insurance. However, other risk factors, such as tibial target, may not be modifiable and a higher readmission rate may need to be accepted in this population.

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“…With the known high costs and resource utilization associated with the management of dialysis access, and the increased risk of readmission in patients with ESRD, enhanced outpatient management could theoretically lead to a decrease in health careeassociated costs. 25 These results not only emphasize the importance of further investigation of antithrombotic management in the perioperative setting but also raise questions about secondary effects of such decisions.…”

Section: Discussionmentioning

confidence: 92%

“…1,24 Patients with ESRD have multiple comorbidities, and given their increased risk for postoperative complications, have elevated rates of readmission and concomitant increased resource utilization. 25 Therefore, management options to both improve clinical outcomes and decrease cost in such patients are desired.…”

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confidence: 99%

Periprocedural Outcomes in Patients on Chronic Anticoagulation Undergoing Fistulograms

Paredes

Arinze

Farber

et al. 2021

Annals of Vascular Surgery

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Background: Management of antithrombotic therapy with warfarin in patients undergoing fistulograms and possible interventions is controversial and difficult because of lack of adequate outpatient bridging options. Our goal was to assess periprocedural outcomes in patients managed using different anticoagulation strategies. Methods: A retrospective, single-institution analysis of all patients on chronic anticoagulation with warfarin undergoing fistulograms from 2011 to 2017 was performed. Anticoagulation management strategies were classified as suspended warfarin (SW), continued warfarin (CW), and a heparin bridge with suspended warfarin (HB). Periprocedural outcomes were analyzed. Results: There were 87 patients on chronic anticoagulation with warfarin who underwent 175 fistulograms. Median age was 63 years, and 43.4% were women. Indications for warfarin included atrial fibrillation (53%), prior pulmonary embolism/deep vein thrombosis (29%), and hypercoagulable state (14%). Distribution was SW (60%), CW (26%), and HB (14%). Approximately half (53%) were same-day procedures, 30% occurred during access-related admissions, and 14% were performed during nonaccess-related admissions. Common indications for a fistulogram included difficulty with dialysis (63.4%), access thrombosis (20.6%), and poor maturation (10.3%). Interventions included angioplasty (82.9%), thrombectomy/embolectomy (20.6%), and stenting (8.6%). Thirty-day outcomes for SW versus CW versus HB were similar for bleeding complications (5.7%, 6.5%, 8.3%; P ¼ 0.89), systemic thrombotic complications (3.8%, 2.2%, 0%; P ¼ 0.569), access rethrombosis (7.6%, 13%, 12.5%; P ¼ 0.517), and tunneled dialysis catheter placement (11.4%, 13%, 12.5%; P ¼ 0.958). After excluding procedures performed during a nonaccess-related admission, length of stay (LOS) was highest among HB (9.6 ± 7.8 days) compared with SW (2.6 ± 5.9 days) and CW (1 ± 2.8 days), (P < 0.0001). Conclusions: CW therapy in patients undergoing fistulograms was not associated with increased morbidity and was associated with shorter LOS. Bridging with heparin is not associated with improved outcomes, warranting a thorough consideration of continuing warfarin is safe and may streamline preservation of dialysis accesses without significantly increasing resource utilization.

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Thirty-day and 90-day hospital readmission after outpatient upper extremity hemodialysis access creation

Abstract: Patients undergoing placement of hemodialysis access are at high risk for readmission mostly from causes unrelated to their operation. This has an effect for global care for these patients as well as care of these patients in accountable care organizations.

Cited by 25 publications

References 24 publications

Readmissions after thoracic endovascular aortic repair

Readmissions after thoracic endovascular aortic repair

Short- and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected

Periprocedural Outcomes in Patients on Chronic Anticoagulation Undergoing Fistulograms

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