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J Surg Res. 2019 Mar;235:270-279. doi: 10.1016/j.jss.2018.10.011. Epub 2018 Nov 1.

Thirty-day Readmission Rates for Carotid Endarterectomy Versus Carotid Artery Stenting.

Author information

1
Division of Outcomes Research and Quality, Department of Surgery, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
2
Division of Outcomes Research and Quality, Department of Surgery, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania; Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania. Electronic address: chollenbeak@psu.edu.

Abstract

BACKGROUND:

Because of the emergence of readmission-related Medicare penalties, efforts are being made to identify and reduce patient readmissions. The purpose of this study was to compare rates and risk factors for 30-d readmission and hospital length of stay (LOS) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) among patients treated for carotid artery stenosis in Pennsylvania.

MATERIALS AND METHODS:

Data were from the Pennsylvania Health Care Cost Containment Council (PHC4). We identified 15,966 patients who underwent CEA (n = 13,557) or CAS (n = 2409) in Pennsylvania between 2011 and 2014. Logistic regression was used to determine risk factors for 30-d readmission, whereas linear regression was used to model factors influencing LOS. Propensity score analysis was used to control for imbalanced covariates between procedures.

RESULTS:

Thirty-day readmission rates in Pennsylvania after CEA and CAS for carotid artery stenosis were similar (9.8% and 9.6%, respectively; P = 0.794). Not home discharge destination, Charlson comorbidity index ≥2, and LOS >1 d were all significantly associated with readmission risk. Procedure type (CEA or CAS) did not significantly influence risk. A significant difference in LOS was found between CEA and CAS, but the magnitude of the difference was small (2.38 for CAS versus 2.59 for CEA; P = 0.007). Black race, urgent and emergent cases, and not home discharges significantly increased LOS by notable amounts (1, 1.5, 3.9, and 1.9 d, respectively).

CONCLUSIONS:

Carotid artery stenosis patients in Pennsylvania undergoing CEA or CAS had similar 30-d readmission rates. Although LOS was significantly different, the magnitude of the difference was not large.

KEYWORDS:

Carotid artery stenting; Carotif endarterectomy; Readmission rates

PMID:
30691806
DOI:
10.1016/j.jss.2018.10.011

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