Reasons for readmission after carotid endarterectomy

World Neurosurg. 2014 Dec;82(6):e771-6. doi: 10.1016/j.wneu.2013.08.020. Epub 2013 Aug 20.

Abstract

Objective: With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).

Methods: Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients. The primary outcome variable was 30-day unplanned readmission. Multiple logistic regression was used, and we controlled for preoperative demographic variables, comorbidities and clinical characteristics, and postoperative medical and surgical complications.

Results: Patients with CEA had a 6.0% unplanned readmission rate. The most common comorbidities in the readmitted patients included hypertension, diabetes, and bleeding disorder. Risk-adjusted multiple regression indicated that preoperative bleeding disorder (odds ratio [OR] 1.62), diabetes (OR 1.46), history of a cerebrovascular accident/stroke (OR 1.46), and increasing age (OR 1.01) were statistically significant predictors for readmission. Postoperatively, surgical-site infection (OR 21.90), myocardial infarction (OR 10.35), sepsis/septic shock (OR 7.79), cerebrovascular accident/stroke (OR 6.58), pneumonia (OR 4.37), and urinary tract infection (OR 3.21) were associated with a greater rate of readmission.

Conclusions: Readmission after CEA occurs at a comparatively high rate. Preoperative bleeding disorders, diabetes, cerebrovascular accidents, and age and postoperative surgical-site infection, myocardial infarction, sepsis/septic shock, pneumonia, and cerebrovascular accident were associated with readmission. These findings may help guide the surgical management of patients and prevent costly readmissions.

Keywords: Carotid endarterectomy; Health policy; Hospital readmissions; Neurosurgery; Vascular surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Benchmarking
  • Comorbidity
  • Endarterectomy, Carotid / adverse effects*
  • Female
  • Humans
  • Male
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy
  • Quality Improvement
  • Risk Adjustment
  • Risk Factors
  • Treatment Outcome