Eric A. Secemsky, MD, MSc; Marc Schermerhorn, MD; Brett J. Carroll, MD; Kevin F. Kennedy, MS; Changyu Shen, PhD; Linda R. Valsdottir, MS; Bruce Landon, MD, MBA; Robert W. Yeh, MD, MSc
Financial Support: By the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
Disclosures: Dr. Schermerhorn reports personal fees from Abbott, Philips, and Cook outside the submitted work. Dr. Landon reports nonfinancial support from the Myers-JDC-Brookdale Institute and the City of Newton, Massachusetts, and personal fees from RTI International, UpToDate, Evidera, the American Board of Internal Medicine, and Freedman Healthcare Consulting outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1058.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Secemsky (e-mail, firstname.lastname@example.org). In addition, the SAS macro used to estimate RSRRs can be obtained from the Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (e-mail, email@example.com). Data set: Publicly available for purchase at www.distributor.hcup-us.ahrq.gov.
Requests for Single Reprints: Robert W. Yeh, MD, MSc, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th Floor, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Secemsky: Massachusetts General Hospital, 55 Fruit Street, GRB 8-852E, Boston, MA 02114.
Dr. Schermerhorn: Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5B, Boston, MA 02215.
Dr. Carroll: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Floor 3, Boston, MA 02215.
Mr. Kennedy: 30 West Pershing Road, Suite 210, Kansas City, MO 64108.
Drs. Shen and Yeh and Ms. Valsdottir: Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th Floor, Boston, MA 02215.
Dr. Landon: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 6, South Suite, Boston, MA 02215-5400.
Author Contributions: Conception and design: E.A. Secemsky, C. Shen.
Analysis and interpretation of the data: E.A. Secemsky, M. Schermerhorn, B.J. Carroll, K.F. Kennedy, R.W. Yeh.
Drafting of the article: E.A. Secemsky, C. Shen, L.R. Valsdottir.
Critical revision of the article for important intellectual content: E.A. Secemsky, M. Schermerhorn, B.J. Carroll, C. Shen, B. Landon, R.W. Yeh.
Final approval of the article: E.A. Secemsky, M. Schermerhorn, B.J. Carroll, K.F. Kennedy, C. Shen, L.R. Valsdottir, B. Landon, R.W. Yeh.
Statistical expertise: E.A. Secemsky, K.F. Kennedy, C. Shen, R.W. Yeh.
Obtaining of funding: E.A. Secemsky, R.W. Yeh.
Administrative, technical, or logistic support: E.A. Secemsky, L.R. Valsdottir, R.W. Yeh.
Collection and assembly of data: E.A. Secemsky.
Limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for peripheral arterial disease. However, the overall burden of readmissions has not been comprehensively explored.
To evaluate nationwide readmissions after peripheral arterial revascularization for peripheral arterial disease and to assess whether readmission risk varies among hospitals.
Retrospective cohort study.
1085 U.S. acute care hospitals participating in the Nationwide Readmissions Database.
61 969 unweighted hospitalizations of patients with peripheral arterial disease who had peripheral arterial revascularization and were discharged alive between 1 January and 30 November 2014.
Thirty-day readmission rates, causes, and costs of unplanned rehospitalizations after peripheral arterial revascularization; 30-day risk-standardized readmission rates (RSRRs), calculated using hierarchical logistic regression, to assess for heterogeneity of readmission risk between hospitals.
Among 61 969 hospitalizations of patients with peripheral arterial disease who were discharged alive after peripheral arterial revascularization, the 30-day nonelective readmission rate was 17.6%. The most common cause of readmission was procedural complications (28.0%), followed by sepsis (8.3%) and complications due to diabetes mellitus (7.5%). Among rehospitalized patients, 21.0% underwent a subsequent peripheral arterial revascularization or lower extremity amputation, 4.6% died, and the median cost of a readmission was $11 013. Thirty-day RSRRs varied from 10.0% to 27.3% (interquartile range, 16.6% to 18.8%).
Inability to distinguish out-of-hospital deaths after discharge and potential misclassification bias due to use of billing codes to ascertain diagnoses and interventions.
More than 1 in 6 patients with peripheral arterial disease who undergo peripheral arterial revascularization have unplanned readmission within 30 days, with high associated mortality risks and costs. Procedure- and patient-related factors were the primary reasons for readmission. Readmission rates varied moderately between institutions after hospital case mix was accounted for, suggesting that differences in hospital quality may only partially account for readmission.
Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
Eric A. Secemsky, Marc Schermerhorn, Brett J. Carroll, Kevin F. Kennedy, Changyu Shen, Linda R. Valsdottir, et al. Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study. Ann Intern Med. [Epub ahead of print 5 December 2017]:. doi: 10.7326/M17-1058
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Published: Ann Intern Med. 2017;1-8.
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