Transitions of care and long-term surveillance after vascular surgery

Hoel, Andrew W.; Zamor, Kimberly C.

doi:10.1053/j.semvascsurg.2015.09.005

Cited by 4 publications

(4 citation statements)

References 52 publications

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“…Furthermore, patients with delirium are more likely to be discharged to other facilities to receive further intermediate-or long-term care, increasing the health care costs significantly. 38 Finally, frailty has been strongly associated with PODE incidence even in patients undergoing vascular surgery procedures. 16,39 However, data collected from the included studies were not sufficient to calculate frailty scores according to criteria used in major frailty scales.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative delirium in patients undergoing vascular surgery

Galyfos

Geropapas

Sianou

et al. 2017

Journal of Vascular Surgery

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This study has confirmed that PODE after vascular surgery procedures is a multifactorial disease, and several independent risk factors have been identified. However, pooled data regarding the effect of PODE on primary outcomes after vascular surgery procedures are still lacking. The results of this review could contribute to the designation of future prediction models and improve prevention of PODE in these patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative delirium in patients undergoing vascular surgery

Galyfos

Geropapas

Sianou

et al. 2017

Journal of Vascular Surgery

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“…Transitioning care from the inpatient hospital setting to either the outpatient or inpatient rehabilitation environment can be challenging, and coordination of care is highly complex. Data have demonstrated that compliance with clinic follow-up after vascular intervention is associated with improved outcomes, 9 and this is even more important after a vascular access complication because that event predicts worse outcomes compared with matched counterparts. 1,3,4,6 Moreover, patients who suffer complications after discharge typically represent within 2 weeks, 21 raising the question of appropriateness for discharge.…”

Section: Discussionmentioning

confidence: 99%

“…8 Longitudinal surveillance and evaluation in the vascular surgery population has been associated with improved outcomes. 9 In this specific population of patients who underwent emergent CFA repair after access complications, the rate of compliance with follow-up clinic visits has not been described and may significantly impact the incidence of wound complications.…”

Section: Introductionmentioning

confidence: 98%

Discharge to a Post-Acute Care Facility after Emergent Femoral Artery Repair is Not Protective Against Wound Complications

Anderson

King

Robison

et al. 2020

Annals of Vascular Surgery

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Background: Access site complication is the most common adverse event after endovascular intervention, and when emergent operative repair of the common femoral artery (CFA) is needed, patient morbidity can be significantly increased. The intent of this project was to identify predictors of wound events after emergent operative repair of the CFA due to an access site complication. It was hypothesized that patients discharged to a facility would benefit from an ongoing relationship with healthcare professionals as evidenced by more consistent follow-up and lower wound complication rates. Methods:Patients who had a percutaneous CFA access complication and required emergent open CFA repair at an academic medical institution between 2015 and 2018 were included, and the charts were reviewed retrospectively. Primary outcomes included wound complication and outpatient compliance with vascular surgery clinic visit. Dichotomous groups were evaluated by the chi-squared test, and continuous variables were evaluated by Student's t-test. Univariate and multivariate regression analyses were completed to assess risk factors contributing to wound event or failure of clinic follow-up.Results: Forty-four patients were identified with emergent CFA repair due to an access complication between July 2015 and June 2018. Among this population, 33% of patients had wound complications and 27% were discharged to a facility. Among those discharged to a facility, the rate of follow-up to the vascular surgeon's clinic was significantly lower than those discharged to home (40% vs. 85%, P < 0.05), and the incidence of wound complications appeared greater but did not reach statistical significance (50% vs. 27%, P = 0.11). Univariate analysis indicated that kidney disease, albumin <3 g/dL, and current smoking were predictive of wound complication, whereas on multivariate analysis, only kidney disease remained predictive (P < 0.05, odds ratio = 22). The modified frailty index (mFI) was not predictive of wound complications or compliance

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“…[1415] It is evident that long-term determinants of readmission are becoming increasingly important, with rehospitalizations beyond the initial postoperative 30-day being both costly and mostly unplanned,[16] yet potentially preventable. [17]…”

Section: Introductionmentioning

confidence: 99%

Temporal variability of readmission determinants in postoperative vascular surgery patients

Lin

Baky

Housley

et al. 2016

Journal of Postgraduate Medicine

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Introduction:Clinical information continues to be limited regarding changes in the temporal risk profile for readmissions during the initial postoperative year in vascular surgery patients. We set out to describe the associations between demographics, clinical outcomes, comorbidity indices, and hospital readmissions in a sample of patients undergoing common extremity revascularization or dialysis access (ERDA) procedures. We hypothesized that factors independently associated with readmission will evolve from “short-term” to “long-term” determinants at 30-, 180-, and 360-day postoperative cutoff points.Methods:Following IRB approval, medical records of patients who underwent ERDA at two institutions were retrospectively reviewed between 2008 and 2014. Abstracted data included patient demographics, procedural characteristics, the American Society of Anesthesiologists score, Goldman Criteria for perioperative cardiac assessment, the Charlson comorbidity index, morbidity, mortality, and readmission (at 30-, 180-, and 360-days). Univariate analyses were performed for readmissions at each specified time point. Variables reaching statistical significance of P < 0.20 were included in multivariate analyses for factors independently associated with readmission.Results:A total of 450 of 744 patients who underwent ERDA with complete medical records were included. Patients underwent either an extremity revascularization (e.g. bypass or endarterectomy, 406/450) or a noncatheter dialysis access procedure (44/450). Sample characteristics included 262 (58.2%) females, mean age 61.4 ± 12.9 years, 63 (14%) emergent procedures, and median operative time 164 min. Median hospital length of stay (index admission) was 4 days. Cumulative readmission rates at 30-, 180-, and 360-day were 12%, 27%, and 35%, respectively. Corresponding mortality rates were 3%, 7%, and 9%. Key factors independently associated with 30-, 180-, and 360-day readmissions evolved over the study period from comorbidity and morbidity-related issues in the short-term to cardiovascular and graft patency issues in the long-term. Any earlier readmission elevated the risk of subsequent readmission.Conclusions:We noted important patterns in the temporal behavior of hospital readmission risk in patients undergoing ERDA. Although factors independently associated with readmission were not surprising (e.g. comorbidity profile, cardiovascular status, and graft patency), the knowledge of temporal trends described in this study may help determine clinical risk profiles for individual patients and guide readmission reduction strategies. These considerations will be increasingly important in the evolving paradigm of value-based healthcare.

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Transitions of care and long-term surveillance after vascular surgery

Cited by 4 publications

References 52 publications

Risk factors for postoperative delirium in patients undergoing vascular surgery

Risk factors for postoperative delirium in patients undergoing vascular surgery

Discharge to a Post-Acute Care Facility after Emergent Femoral Artery Repair is Not Protective Against Wound Complications

Temporal variability of readmission determinants in postoperative vascular surgery patients

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