- Email: [email protected]
Hospital Readmission and Emergency Department Visits After Vascular Surgery: A Prospective Cohort Study
e80
Abstracts
Journal of Vascular Surgery September 2017
effect of renin-angiotensin system blockade on AAA growth, rupture, and perioperative mortality. Author Disclosures: K. Salata: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; R. Eikelboom: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Syed: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Hussain: Nothing to disclose; N. Alsaif: Nothing to disclose; S. Verma: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Al-Omran: Nothing to disclose.
Hospital Readmission and Emergency Department Visits After Vascular Surgery: A Prospective Cohort Study Mohamad A. Hussain,1,2 Zeyad Khoshhal,2 Konrad Salata,1,2 Baidaa Altuwaijri,2 Norah Alsaif,2 Subodh Verma,1,3,4 Mohammed Al-Omran1,2,4. 1Department of Surgery, University of Toronto, Toronto, Ontario, Canada; 2Division of Vascular Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; 3Division of Cardiac Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; 4Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Objective: The objective of this study was to establish the rates and causes of hospital readmission and emergency department (ED) visits after vascular surgery and to understand how these patients are managed. Methods: We conducted a prospective observational cohort study at a single tertiary center in Toronto, Ontario. We enrolled all inpatients who underwent a vascular surgery procedure between September 2015 and June 2016 and followed them up at 30 days after discharge using telephone interviews. We established baseline patient characteristics and gathered follow-up data on readmissions and ED visits. Results: A total of 133 patients were enrolled. Mean age (standard deviation) was 65.3 (13.1) years; 29% were women. The most common index admission diagnoses were peripheral arterial disease (50%), abdominal aortic aneurysm (25%), and carotid stenosis (9%). Of the 128 patients who were discharged home and were alive at 30-day follow-up, 19 (15%) had been readmitted or had visited the ED. Rates of readmission or ED visit varied on the basis of the index procedure (Fig 1), urgency of the procedure (Fig 2, A), and residing distance from the treating hospital (Fig 2, B), although these differences did not reach statistical significance. Patients were readmitted a mean of 17 days after discharge (n ¼ 10); surgical site infection was the most common cause of readmission (30%); the primary treatment was antimicrobial therapy or surgical in 40% and 30% of the cases, respectively; and the mean length of stay after readmission was 14 days. With respect to ED visits (n ¼ 9), patients presented a mean of 11 days after discharge; they most commonly reported a wound issue (67%) or lower extremity edema (22%); and they were managed with either oral antibiotics (67%) or reassurance (33%).
Fig 1. Rate of readmission or emergency department (ED) visit by index procedure. EVAR, Endovascular aneurysm repair; LE, lower extremity; UE, upper extremity.
Fig 2. Rate of readmission or emergency department (ED) visit by urgency of procedure (A) and the patient’s residing distance from the treating hospital (B).
Conclusions: Early readmission or ED visit after vascular surgery is common, often due to surgical site infection or wound-related issues. Hospital-based and outpatient quality initiatives may help reduce these events. Author Disclosures: M. Hussain: Nothing to disclose; Z. Khoshhal: Nothing to disclose; K. Salata: Nothing to disclose; B. Altuwaijri: Nothing to disclose; N. Alsaif: Nothing to disclose; S. Verma: Nothing to disclose; M. Al-Omran: Nothing to disclose.
Assessing Patient Preferences for and Ranking of Outcomes Presented in Randomized Trials of Endovascular Aortic Surgery (APPROPRIATE) Danielle Dion,1 Adam Power,1 Guy DeRose,1 Audra Duncan,1 Thomas Forbes,2 Luc Dubois1. 1Division of Vascular Surgery, Western Univer2 sity, London, Ontario, Canada; Division of Vascular Surgery, University of Toronto, Ontario, Canada Background: We surveyed both abdominal aortic aneurysm (AAA) patients undergoing surveillance and vascular surgeons to assess their preference for and ranking of both traditional and functional outcomes after AAA repair. Methods: Patients with AAA between 3.0 and 5.0 cm who were undergoing surveillance were surveyed during clinic visits; an Internet-based survey was sent to all members of the Canadian Society for Vascular Surgery. We asked each respondent to rate the importance of 19 unique outcomes after AAA surgery. Each response was coded using a 5-point Likert scale (1, not important; 5, most important). We compared responses using t-test. Results: The questionnaires were completed by 100 patients (mean age, 68 years) and 66 surgeons (mean age, 48 years). Both surgeons and patients scored avoiding early postoperative mortality, ability to return home and to function independently, and avoiding postoperative complications as the most important outcomes after AAA repair. Patients placed more importance on avoiding an aortic reintervention than surgeons did; 63% of patients indicated it was either very important or most important, whereas only 31% of surgeons thought it was
Fig. Relative importance of avoiding an aortic reintervention as rated by both surgeons and patients. (Likert scale: 1, not important; 2, somewhat important; 3, important; 4, very important; 5, most important.)
Abstracts
Journal of Vascular Surgery September 2017
effect of renin-angiotensin system blockade on AAA growth, rupture, and perioperative mortality. Author Disclosures: K. Salata: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; R. Eikelboom: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Syed: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Hussain: Nothing to disclose; N. Alsaif: Nothing to disclose; S. Verma: Off-label use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers for reduction of AAA growth, rupture, perioperative mortality; M. Al-Omran: Nothing to disclose.
Hospital Readmission and Emergency Department Visits After Vascular Surgery: A Prospective Cohort Study Mohamad A. Hussain,1,2 Zeyad Khoshhal,2 Konrad Salata,1,2 Baidaa Altuwaijri,2 Norah Alsaif,2 Subodh Verma,1,3,4 Mohammed Al-Omran1,2,4. 1Department of Surgery, University of Toronto, Toronto, Ontario, Canada; 2Division of Vascular Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; 3Division of Cardiac Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada; 4Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Objective: The objective of this study was to establish the rates and causes of hospital readmission and emergency department (ED) visits after vascular surgery and to understand how these patients are managed. Methods: We conducted a prospective observational cohort study at a single tertiary center in Toronto, Ontario. We enrolled all inpatients who underwent a vascular surgery procedure between September 2015 and June 2016 and followed them up at 30 days after discharge using telephone interviews. We established baseline patient characteristics and gathered follow-up data on readmissions and ED visits. Results: A total of 133 patients were enrolled. Mean age (standard deviation) was 65.3 (13.1) years; 29% were women. The most common index admission diagnoses were peripheral arterial disease (50%), abdominal aortic aneurysm (25%), and carotid stenosis (9%). Of the 128 patients who were discharged home and were alive at 30-day follow-up, 19 (15%) had been readmitted or had visited the ED. Rates of readmission or ED visit varied on the basis of the index procedure (Fig 1), urgency of the procedure (Fig 2, A), and residing distance from the treating hospital (Fig 2, B), although these differences did not reach statistical significance. Patients were readmitted a mean of 17 days after discharge (n ¼ 10); surgical site infection was the most common cause of readmission (30%); the primary treatment was antimicrobial therapy or surgical in 40% and 30% of the cases, respectively; and the mean length of stay after readmission was 14 days. With respect to ED visits (n ¼ 9), patients presented a mean of 11 days after discharge; they most commonly reported a wound issue (67%) or lower extremity edema (22%); and they were managed with either oral antibiotics (67%) or reassurance (33%).
Fig 1. Rate of readmission or emergency department (ED) visit by index procedure. EVAR, Endovascular aneurysm repair; LE, lower extremity; UE, upper extremity.
Fig 2. Rate of readmission or emergency department (ED) visit by urgency of procedure (A) and the patient’s residing distance from the treating hospital (B).
Conclusions: Early readmission or ED visit after vascular surgery is common, often due to surgical site infection or wound-related issues. Hospital-based and outpatient quality initiatives may help reduce these events. Author Disclosures: M. Hussain: Nothing to disclose; Z. Khoshhal: Nothing to disclose; K. Salata: Nothing to disclose; B. Altuwaijri: Nothing to disclose; N. Alsaif: Nothing to disclose; S. Verma: Nothing to disclose; M. Al-Omran: Nothing to disclose.
Assessing Patient Preferences for and Ranking of Outcomes Presented in Randomized Trials of Endovascular Aortic Surgery (APPROPRIATE) Danielle Dion,1 Adam Power,1 Guy DeRose,1 Audra Duncan,1 Thomas Forbes,2 Luc Dubois1. 1Division of Vascular Surgery, Western Univer2 sity, London, Ontario, Canada; Division of Vascular Surgery, University of Toronto, Ontario, Canada Background: We surveyed both abdominal aortic aneurysm (AAA) patients undergoing surveillance and vascular surgeons to assess their preference for and ranking of both traditional and functional outcomes after AAA repair. Methods: Patients with AAA between 3.0 and 5.0 cm who were undergoing surveillance were surveyed during clinic visits; an Internet-based survey was sent to all members of the Canadian Society for Vascular Surgery. We asked each respondent to rate the importance of 19 unique outcomes after AAA surgery. Each response was coded using a 5-point Likert scale (1, not important; 5, most important). We compared responses using t-test. Results: The questionnaires were completed by 100 patients (mean age, 68 years) and 66 surgeons (mean age, 48 years). Both surgeons and patients scored avoiding early postoperative mortality, ability to return home and to function independently, and avoiding postoperative complications as the most important outcomes after AAA repair. Patients placed more importance on avoiding an aortic reintervention than surgeons did; 63% of patients indicated it was either very important or most important, whereas only 31% of surgeons thought it was
Fig. Relative importance of avoiding an aortic reintervention as rated by both surgeons and patients. (Likert scale: 1, not important; 2, somewhat important; 3, important; 4, very important; 5, most important.)