کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5733670 | 1612511 | 2018 | 8 صفحه PDF | دانلود رایگان |
BackgroundReadmission within 30Â d of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNFs), making postacute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery.MethodsWe utilize the Centers for Medicare & Medicaid Services Chronic Conditions Warehouse, a longitudinal 5% national random sample of Medicare beneficiaries to study 30-day readmission or death after discharge to SNF following abdominal aortic aneurysm repair or lower extremity revascularization from 2005-2009. Descriptive statistics and logistic regression with Least Adaptive Shrinkage and Selection Operator were used for analysis.ResultsTwo thousand one hundred ninety-seven patients underwent an abdominal aortic aneurysm procedure or lower extremity revascularization at 686 hospitals and discharged to 1714 SNFs. Eight hundred (36%) were readmitted or had died at 30Â d. In adjusted analysis, predictors of readmission or death at 30Â d included SNF for-profit status (OR [odds ratio]Â =Â 1.2; PÂ =Â 0.032), number of hospitalizations in the previous year (ORÂ =Â 1.06; PÂ =Â 0.011), number of comorbidities (ORÂ =Â 1.06; PÂ =Â 0.004), emergent procedure (ORÂ =Â 1.69; PÂ <Â 0.001), renal complication (ORÂ =Â 1.38; PÂ =Â 0.003), respiratory complication (ORÂ =Â 1.45; PÂ <Â 0.001), thromboembolic complication (ORÂ =Â 1.57; PÂ =Â 0.019), and wound complication (ORÂ =Â 0.70; PÂ =Â 0.017).ConclusionsPatients discharged to SNF following vascular surgery have exceptionally high rates of readmission or death at 30Â d. Many factors predicting readmission or death potentially modify decision-making around discharge, making early detection, discharge planning, and matching patient needs to SNF capabilities essential to improving outcomes.
Journal: Journal of Surgical Research - Volume 221, January 2018, Pages 196-203