Examining Care Fragmentation After PAD Interventions: The Readmission Event Open Access
Alabi, Olamide (Spring 2023)
Abstract
Background
Lower extremity revascularization (LER) for peripheral artery disease (PAD) is complicated by the frequent need for readmission. However, it is unclear if readmission at a non-index LER facility (i.e., a facility different from the one where the LER was performed) compared to the index LER facility is associated with worse outcomes.
Methods
This was a national cohort study of older adults who underwent open, endovascular, or hybrid LER for PAD (January 1, 2010 – December 31, 2018) in the Vascular Quality Initiative. This dataset was linked to Medicare claims and the American Hospital Association Annual Survey. The primary outcome was 90-day mortality and secondary outcomes were major amputation at 30- and 90-days after LER. The primary exposure was the first readmission after LER (categorized as occurring at the index LER facility versus a non-index LER facility). Multivariable logistic regression was used to assess the association between 90-day mortality and readmission location.
Results
Among 13,206 patients readmitted within 90-days of LER for PAD, 27.3% were readmitted to a non-index LER facility. Compared to patients readmitted to the index LER facility, those readmitted to a non-index facility had a lower proportion of procedure-related reasons for readmission (21.5% vs 50.1%, p<0.001). Most of the patients readmitted to a non-index LER facility lived further than 31 miles from the index LER facility (39.2% vs 19.6%, p<0.001) and were readmitted to a facility with a total bed size under 250 (60.1% vs 11.9%, p<0.001). Readmission to a non-index LER facility within 90-days was not associated with 90-day mortality, 30-day amputation, or 90-day amputation. However, readmission to a non-index LER facility with a procedure-related complication was associated with major amputation (30-day amputation: aOR 3.58 [95% CI, 3.00-4.27]; 90-day amputation: aOR 3.33 [95% CI, 2.93-3.80]).
Conclusion
While care fragmentation and readmission to a different facility after LER for PAD is not associated with amputation or death within 90-days, readmission for procedure-related complications is significantly associated with subsequent amputation. Quality improvement efforts should focus on understanding the role discontinuity of care plays in limb salvage as well as the reasons care fragmentation is associated with procedure-related failure.
Table of Contents
Introduction…………………………………………………………………………...9
Background….………………………………………………………………………..10
Methods........................................................................................... 12
Results…………………………………………………………………………………19
Discussion.……………………………………………………………………………22
References…………………………………………………………………………….26
Tables/Figures….………………………………………………………………...28-33
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