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PC54. Predictors of Hospital Readmissions after Lower Extremity Amputations in Canada
JOURNAL OF VASCULAR SURGERY June Supplement 2015
132S Abstracts
Author Disclosures: K. Allen: Nothing to disclose; G. R. Dryton: Nothing to disclose; A. Borkon: Nothing to disclose; S. Agarwall: Nothing to disclose; J. R. Davis: Nothing to disclose; A. Pak: Nothing to disclose; J. R. Stewart: Nothing to disclose; R. S. Stuart: Nothing to disclose. PC54. Predictors of Hospital Readmissions after Lower Extremity Amputations in Canada Ahmed Kayssi, Charles de Mestral, Thomas L. Forbes, Graham Roche-Nagle. University of Toronto, Toronto, Ontario, Canada Objectives: This study described the factors associated with early (#30 days) and late (30-365 days) hospital readmissions after lower extremity amputations in Canada. Methods: A retrospective cohort study was carried out of all Canadian adults who underwent elective lower extremity amputations in the years 2006 to 2008 for nontraumatic indications. Patients were identified from the Canadian Institute for Health Information’s Discharge Abstract Database that includes all hospital admissions across Canada, with the exception of the Province of Quebec. Results: During the study period, 3823 patients underwent lower limb amputations (major amputations, 95%) and 2116 (55.4%) were readmitted at least once. Of those, 1112 readmissions (29.1%) were early, #30 days (mean, 5.0 6 8.3 days postdischarge) and 1004 (26.3%) were late, between 30 and 365 days (mean, 151.4 6 95.9 days postdischarge). Stump complications accounted for 8.5% and 6.5% of early and late readmissions, respectively. Stump revision surgery was performed in 301 readmitted patients (7.9%). Predictors of early readmission included amputation by a vascular surgeon (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9), female gender (OR. 1.2; 95% CI, 1.1-1.5), and a short (<7 day) admission (OR, 1.7; 95% CI, 1.4-2.1). Predictors of late readmission included a longer ($7 days) admission (OR, 1.5; 95% CI, 1.2-1.8), discharge to a long-term care facility (OR, 3.3; 95% CI, 2.7-3.9), and home discharge with community supports (OR, 2.3; 95% CI, 1.8-2.9). Conclusions: Half of patients undergoing lower-extremity amputations are readmitted to hospital #1 year. Markers of patient dependence (long hospitalization, discharge to long-term care facility) predict late readmission. Lengthening the perioperative hospitalization period may decrease the chances of early readmission in this vulnerable patient population. Author Disclosures: A. Kayssi: Nothing to disclose; C. de Mestral: Nothing to disclose; T. L. Forbes: Nothing to disclose; G. Roche-Nagle: Cook Medical and Cordis, consulting fee. PC56. The Impact of Vascular Surgery Wound Complications on Quality of Life Edward A. McGillicuddy1, C. Keith Ozaki1, Samir K. Shah1, Michael Belkin1, Allen H. Hamdan3, Neal R. Barshes2, Mark C. Wyers3, Louis L. Nguyen1. 1Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; 2Baylor College of Medicine, Missouri City, Tex; 3 BIDMC, Harvard Medical School, Boston, Mass
Objectives: In addition to traditional surgical outcomes, perioperative quality of life (QoL) is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in the context of postoperative wound complications. We hypothesized that wound complications negatively impact QoL. Methods: EQ-5D subjective health state data, comprising five domains with 1 to 3 ordinal scoring (1 ¼ good, 3 ¼ poor), plus analog score, were collected at the day of surgery, and at 2 and 4 weeks’ follow-up (FU) in a study evaluating silver-eluting dressings in 500 patients at three centers. Groups were defined based on absence (NC) or presence (WC) of one or more postoperative wound complications. Results: Mean patient age was 67.6; 72.2% were male. Primary indications included critical limb ischemia (41.4%), claudication (31.6%), and abdominal aortic aneurysm (11.2%; open groin access for endovascular repair). At least one WC occurred in 148 patients (29.6%). A total of 774 of 929 (83.3%) of FU visits included EQ-5D data in all six dimensions. There was no difference in the WC/NC groups in three basic demographic, eight laboratory, and eight medical history variables (P > .05 for all). Among seven recorded surgical indications, mean analog heath state scores were lowest in the tissue loss group (55.1) and highest in the AAA group (71.9; analysis of variance P < .001). Although mean overall baseline and FU health analog scores were not different in the WC (66.8) and NC (67.8) groups (P ¼ .44); mobility (P < .001), self-care (P ¼ .01); usual activities (P ¼ .03), and pain (P < .001) scores demonstrated increased disability in the WC group (Table). Intensive care unit length of stay, and discharge to rehabilitation, nursing home, or hospice was associated with lower mean analog health score (P < .001 for both). Conclusions: Postoperative lower extremity wound complications result in short-term QoL decrements in several domains, highlighting the patient-centric morbidity of these complications beyond their health and economic impacts. Table. EQ-5D Domain
Group
Mobility
NC WC NC WC NC WC NC WC NC WC NC WC
Self-care Usual Activities Pain-discomfort Anxiety-depression Analog Health State
Baseline
2 weeks FU
4 weeks FU
P
1.90 1.91 1.17 1.16 1.64 1.66 1.91 2.00 1.40 1.39 62.5 61.4
1.69 1.84 1.25 1.36 1.80 1.96 1.68 1.87 1.30 1.38 69.1 68.0
1.59 1.75 1.16 1.26 1.66 1.76 1.63 1.82 1.26 1.31 69.4 68.7
<.001 .01 .03 <.001 .38 .44
FU, Follow-up; NC, no wound complication; WC, wound complication.
Author Disclosures: E. A. McGillicuddy: Nothing to disclose; C. Ozaki: Smith & Nephew Inc, Novartis Biomedical Institute, contracted research; Neograft Technologies, consulting fee; S. K. Shah: Nothing to disclose; M. Belkin: Medtronic Spine Division, consulting fee; A. H. Hamdan: Nothing to disclose; N. R. Barshes: Nothing to disclose; M. C. Wyers: Nothing to disclose; L. L. Nguyen: Nothing to disclose.
132S Abstracts
Author Disclosures: K. Allen: Nothing to disclose; G. R. Dryton: Nothing to disclose; A. Borkon: Nothing to disclose; S. Agarwall: Nothing to disclose; J. R. Davis: Nothing to disclose; A. Pak: Nothing to disclose; J. R. Stewart: Nothing to disclose; R. S. Stuart: Nothing to disclose. PC54. Predictors of Hospital Readmissions after Lower Extremity Amputations in Canada Ahmed Kayssi, Charles de Mestral, Thomas L. Forbes, Graham Roche-Nagle. University of Toronto, Toronto, Ontario, Canada Objectives: This study described the factors associated with early (#30 days) and late (30-365 days) hospital readmissions after lower extremity amputations in Canada. Methods: A retrospective cohort study was carried out of all Canadian adults who underwent elective lower extremity amputations in the years 2006 to 2008 for nontraumatic indications. Patients were identified from the Canadian Institute for Health Information’s Discharge Abstract Database that includes all hospital admissions across Canada, with the exception of the Province of Quebec. Results: During the study period, 3823 patients underwent lower limb amputations (major amputations, 95%) and 2116 (55.4%) were readmitted at least once. Of those, 1112 readmissions (29.1%) were early, #30 days (mean, 5.0 6 8.3 days postdischarge) and 1004 (26.3%) were late, between 30 and 365 days (mean, 151.4 6 95.9 days postdischarge). Stump complications accounted for 8.5% and 6.5% of early and late readmissions, respectively. Stump revision surgery was performed in 301 readmitted patients (7.9%). Predictors of early readmission included amputation by a vascular surgeon (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9), female gender (OR. 1.2; 95% CI, 1.1-1.5), and a short (<7 day) admission (OR, 1.7; 95% CI, 1.4-2.1). Predictors of late readmission included a longer ($7 days) admission (OR, 1.5; 95% CI, 1.2-1.8), discharge to a long-term care facility (OR, 3.3; 95% CI, 2.7-3.9), and home discharge with community supports (OR, 2.3; 95% CI, 1.8-2.9). Conclusions: Half of patients undergoing lower-extremity amputations are readmitted to hospital #1 year. Markers of patient dependence (long hospitalization, discharge to long-term care facility) predict late readmission. Lengthening the perioperative hospitalization period may decrease the chances of early readmission in this vulnerable patient population. Author Disclosures: A. Kayssi: Nothing to disclose; C. de Mestral: Nothing to disclose; T. L. Forbes: Nothing to disclose; G. Roche-Nagle: Cook Medical and Cordis, consulting fee. PC56. The Impact of Vascular Surgery Wound Complications on Quality of Life Edward A. McGillicuddy1, C. Keith Ozaki1, Samir K. Shah1, Michael Belkin1, Allen H. Hamdan3, Neal R. Barshes2, Mark C. Wyers3, Louis L. Nguyen1. 1Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; 2Baylor College of Medicine, Missouri City, Tex; 3 BIDMC, Harvard Medical School, Boston, Mass
Objectives: In addition to traditional surgical outcomes, perioperative quality of life (QoL) is being scrutinized as a patient-centric metric. As part of a prospective study in a contemporary surgical cohort, subjective health states were examined in the context of postoperative wound complications. We hypothesized that wound complications negatively impact QoL. Methods: EQ-5D subjective health state data, comprising five domains with 1 to 3 ordinal scoring (1 ¼ good, 3 ¼ poor), plus analog score, were collected at the day of surgery, and at 2 and 4 weeks’ follow-up (FU) in a study evaluating silver-eluting dressings in 500 patients at three centers. Groups were defined based on absence (NC) or presence (WC) of one or more postoperative wound complications. Results: Mean patient age was 67.6; 72.2% were male. Primary indications included critical limb ischemia (41.4%), claudication (31.6%), and abdominal aortic aneurysm (11.2%; open groin access for endovascular repair). At least one WC occurred in 148 patients (29.6%). A total of 774 of 929 (83.3%) of FU visits included EQ-5D data in all six dimensions. There was no difference in the WC/NC groups in three basic demographic, eight laboratory, and eight medical history variables (P > .05 for all). Among seven recorded surgical indications, mean analog heath state scores were lowest in the tissue loss group (55.1) and highest in the AAA group (71.9; analysis of variance P < .001). Although mean overall baseline and FU health analog scores were not different in the WC (66.8) and NC (67.8) groups (P ¼ .44); mobility (P < .001), self-care (P ¼ .01); usual activities (P ¼ .03), and pain (P < .001) scores demonstrated increased disability in the WC group (Table). Intensive care unit length of stay, and discharge to rehabilitation, nursing home, or hospice was associated with lower mean analog health score (P < .001 for both). Conclusions: Postoperative lower extremity wound complications result in short-term QoL decrements in several domains, highlighting the patient-centric morbidity of these complications beyond their health and economic impacts. Table. EQ-5D Domain
Group
Mobility
NC WC NC WC NC WC NC WC NC WC NC WC
Self-care Usual Activities Pain-discomfort Anxiety-depression Analog Health State
Baseline
2 weeks FU
4 weeks FU
P
1.90 1.91 1.17 1.16 1.64 1.66 1.91 2.00 1.40 1.39 62.5 61.4
1.69 1.84 1.25 1.36 1.80 1.96 1.68 1.87 1.30 1.38 69.1 68.0
1.59 1.75 1.16 1.26 1.66 1.76 1.63 1.82 1.26 1.31 69.4 68.7
<.001 .01 .03 <.001 .38 .44
FU, Follow-up; NC, no wound complication; WC, wound complication.
Author Disclosures: E. A. McGillicuddy: Nothing to disclose; C. Ozaki: Smith & Nephew Inc, Novartis Biomedical Institute, contracted research; Neograft Technologies, consulting fee; S. K. Shah: Nothing to disclose; M. Belkin: Medtronic Spine Division, consulting fee; A. H. Hamdan: Nothing to disclose; N. R. Barshes: Nothing to disclose; M. C. Wyers: Nothing to disclose; L. L. Nguyen: Nothing to disclose.