Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery

Abstract

Background Readmission within 30 days of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNF), making post-acute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery. Materials and Methods We utilize the CMS Chronic Conditions Warehouse, a longitudinal 5% national random sample of Medicare beneficiaries to study 30-day readmission or death after discharge to SNF following abdominal aortic aneurysm (AAA) repair or lower extremity revascularization (LER) from 2005–2009. Descriptive statistics and logistic regression with LASSO (Least Adaptive Shrinkage and Selection Operator) were used for analysis. Results 2197 patients underwent an AAA procedure or LER at 686 hospitals and discharged to 1714 SNF. 800 (36%) were readmitted or had died at 30 days. In adjusted analysis, predictors of readmission or death at 30 days included SNF for-profit status (OR=1.2; p=0.032), number of hospitalizations in the previous year (OR=1.06; p=0.011), number of comorbidities (OR=1.06; p=0.004), emergent procedure (OR=1.69; p<0.001), renal complication (OR=1.38; p=0.003), respiratory complication (OR=1.45; p<0.001), thromboembolic complication (OR=1.57; p=0.019), and wound complication (OR=0.70; p=0.017). Discussion Patients discharged to SNF following vascular surgery have exceptionally high rates of readmission or death at 30 days. Many factors predicting readmission or death potentially modify decision-making around discharge, making early detection, discharge planning, and matching patient needs to SNF capabilities essential to improving outcomes.

Discharge to skilled-care or rehabilitation following elective anterior cervical discectomy and fusion increases the risk of 30-day re-admissions and post-discharge complications

“…The current study's findings following post-acute care is similar to that reported for lumbar fusion surgeries by Cook et al (7). Though studies on postdischarge outcomes are limited in spine literature, other surgical literature has reported similar findings of SNF discharge negatively impacting re-admissions (10,11,13). However, it is imperative to keep in mind the variation in the nature of surgical procedures within the studies.…”

“…However, it is imperative to keep in mind the variation in the nature of surgical procedures within the studies. Fernandes-Taylor et al assessed 30-day readmissions and mortality among Medicare beneficiaries discharged to SNF following an abdominal aortic aneurysm (AAA) repair or lower extremity re-vascularization (13). Similarly, Ottenbacher et al reported that around 12% of patients who were discharged to a rehabilitation facility following acute hospitalization for stroke, lower extremity fracture, joint replacement, debility, neurologic disorders and brain dysfunction were re-admitted, with 50% of those cases occurring within 11 days following discharge (14).…”

Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

“…Such high rates of home discharge are noteworthy among a cohort of elderly and morbid patients. In prior investigations, discharge to SNF was identified as a significant predictor of readmission after cardiovascular procedures . This may suggest that although patients undergoing TMVR may be a sicker population, in the current era those who are healthy enough for home discharge are likely optimized medically prior to discharge.…”

Nursing home leaders’ and nurses’ experiences of resources, staffing and competence levels and the relation to hospital readmissions – a case study

“…Thirty-day hospital readmissions are challenging for healthcare services internationally, signalling an increased prevalence of adverse events, and reduced quality of care. They contribute to major strains on healthcare services’ resources and finances [1]. In Norway hospital readmissions have been an increasing problem over the past five years, with readmission rates ranging from 10.3 - 22.9% across different municipalities that provide primary health and social care [2].…”