Diagnoses and clinical features associated with high risk for unplanned readmission in vascular surgery. A cohort study

• Lower limb ischaemia and diabetic foot sepsis are the two diagnoses with the highest readmission rate.
• Vascular patients are more frequently readmitted for medical rather than surgical health problems.
• For vascular patients, the most common medical, readmission diagnoses are infection renal disease complications and COPD exacerbation.
• Most of the patients readmitted under vascular surgery necessitate further surgical treatment.
• Diabetes may be an independent risk factor for readmission.

BackgroundReadmission rate is an established health quality indicator. Preventable readmissions bear an unnecessary, high cost on the healthcare system. An analysis performed by the National Centre for Health Outcomes Development (NCHOD) has demonstrated an increasing trend in emergency readmissions in the UK. Vascular surgery has been reported to have high readmission rates second only to congestive heart failure. This study aims to identify diagnoses and other clinical risk factors for high unplanned readmission rates. This may be the first step to sparing both the health care system and patients of unnecessary readmissions.ResultsThe overall 30 day readmission rate for Leeds Vascular Institute was 8.8%. The two diagnoses with the highest readmission rates were lower limb ischaemia and diabetic foot sepsis. The readmission rate for medical reasons was overwhelmingly higher than for surgical reasons (6.5% and 2.3% respectively). The most common medical diagnoses were renal disease and COPD. The majority of the patients readmitted under the care of vascular surgery required further surgical treatment.ConclusionVascular units should focus on holistic and multidisciplinary treatment of lower limb ischaemia and diabetic foot sepsis, in order to prevent readmissions. Furthermore, the early involvement and input of physicians in the treatment of vascular patients with renal disease and COPD may be appropriate.