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When patients are discharged from hospital after surgery, home care support can be provided to optimize their recovery at home. (1) In a recent study of vascular surgery quality outcomes [...], Background: Recent evidence suggests that home care nursing is variably prescribed after vascular surgery, and may reduce emergency department visits and hospital readmissions. We therefore sought to characterize the indications for home care nursing following vascular surgery from the surgeon's perspective. Methods: An online survey was distributed to the 141 members of the Canadian Society for Vascular Surgery with questions related to home care nursing after carotid endarterectomy (CEA), endovascular aortic aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair and open or hybrid revascularization for peripheral arterial disease (PAD). We included all questionnaires in our analysis; the frequency denominator changes according to the number of respondents who completed each survey item. Results: There were 46 survey respondents (33% of 141) from across the country. A total of 28 (62% of 45) worked in a teaching hospital. Home care nursing was routinely prescribed by 5%, 10%, 31% and 41% of respondents following CEA, EVAR, open AAA repair and open or hybrid revascularization for PAD, respectively. Across all procedure types, the same procedure-related criteria were most often deemed to warrant a prescription for home care nursing: surgical site infection, wound complications (e.g., open wound, lymphatic leak) and use of negative-pressure wound therapy. Across all procedure types, lack of social support, physical frailty and cognitive impairment were most frequently identified as patient-specific considerations for prescribing home care nursing. Few respondents reported restrictions or standards that informed their prescribing practice. Conclusion: Most surgeon respondents agreed on the indications for home care nursing after vascular surgery. However, evidence-based standards to guide patient selection for home care nursing after vascular surgery are needed. Contexte : Selon des donnees recentes, les soins infirmiers a domicile sont prescrits aleatoirement apres la chirurgie vasculaire, et pourraient reduire les consultations aux urgences et les rehospitalisations. Nous avons donc voulu caracteriser les indications des soins infirmiers a domicile apres la chirurgie vasculaire, du point de vue des chirurgiens. Methodes : Nous avons transmis un sondage en ligne aux 141 membres de la Societe canadienne de chirurgie vasculaire (SCCV); les questions portaient sur les soins infirmiers a domicile apres l'endarteriectomie carotidienne, la reparation endovasculaire de l'anevrisme de l'aorte, la reparation chirurgicale de l'anevrisme de l'aorte abdominale (AAA) et la revascularisation chirurgicale ou hybride de la maladie arte rielle peripherique (MAP). Nous avons inclus tous les questionnaires dans notre analyse; le denominateur de frequence change en fonction du nombre de repondants qui ont repondu a chaque element du sondage. Resultats : Quarante-six chirurgiens des quatre coins du pays ont repondu (33 % des 141 membres de la SCCV). En tout, 28 (62 % des of 45) travaillaient dans un etablissement universitaire. Les soins infirmiers a domicile etaient prescrits d'emblee par 5 %, 10 %, 31 % et 41 % des repondants suite a l'endarteriectomie carotidienne, la reparation endovasculaire de l'anevrisme de l'aorte, la chirurgie pour AAA et la revascularisation chirurgicale ou hybride de la MPA, respectivement. Pour tous les types d'interventions, les memes criteres lies aux interventions ont semble justifier la pres cription de soins infirmiers a domicile : infection de plaie, complications au niveau de la plaie (p. ex., plaie ouverte, plaie exsudative) et traitement de plaie par pression negative. Pour tous les types d'intervention, l'absence de soutien social, la fragilite physique et le declin cognitif ont le plus souvent ete identifies parmi les criteres specifiques aux patients pour la prescription de soins infirmiers a domicile. Peu de repondants ont mentionne de possibles restrictions ou normes sur lesquelles fonder leurs habitudes de prescription a ce chapitre. Conclusion : La plupart des chirurgiens participants se sont entendus sur les indications des soins infirmiers a domicile apres la chirurgie vasculaire. Il faudrait toutefois etablir des normes fondees sur des donnees probantes pour guider la selection des patients candidats aux soins infirmiers a domicile apres la chirurgie vasculaire.

Hospital readmission following major surgery is common and expensive and can serve as a marker for quality of care provided. In 2004, nearly 1 in 5 Medicare beneficiaries were readmitted [...], Background: Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. Methods: We conducted a prospective observational cohort study including all in patients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. Results: We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. Conclusion: Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events. Contexte : Les taux de readmission a l'hopital apres une chirurgie peuvent servir d'indicateur de la qualite des soins. L'etude visait a determiner les taux et les causes de readmissions et de visites a l'urgence chez les patients ayant subi une chirurgie vasculaire et a etudier la facon dont ces patients etaient pris en charge. Methodes : Nous avons mene une etude de cohorte observationnelle prospective portant sur tous les patients qui ont ete hospitalises pour une importante chirurgie vasculaire entre septembre 2015 et juin 2016 dans un centre de soins tertiaires vasculaires a Toronto. Nous avons fait un suivi telephonique aupres de ces patients 30 jours apres leur conge. Resultats : Nous avons recrute 133 patients (94 hommes [70,7 %] et 39 femmes [29,3 %] dont l'age moyen etait de 65,3 ans). Le diagnostic le plus courant a l'admission initiale etait la maladie arterielle peripherique (67 patients [50,4 %]). A 30 jours, 19 patients (14,8 %) avaient ete rehospitalises ou s'etaient presentes a l'urgence; la plupart avaient initialement subi une revascularisation des membres inferieurs (19,4 %). Dix patients ont ete rehospitalises en moyenne 16,8 jours apres leur conge; l'infection du site operatoire etait la cause la plus courante de readmission (3 patients). Le traitement le plus courant chez les patients rehospitalises etait le traite ment antimicrobien (4 patients). La duree mediane des sejours a l'hopital etait de 14,4 jours. Neuf patients se sont presentes a l'urgence en moyenne 10,6 jours apres leur conge; 6 ont signale un probleme avec leur plaie, et la majorite (6 des 9 patients) ont recu une antibiotherapie orale. Conclusion : Les readmissions ou les visites a l'urgence de patients atteints d'une maladie arterielle peripherique peu apres une chirurgie de revascularisation des membres inferieurs sont courantes et souvent attribuables a une infection du site operatoire ou a des problemes associes a la plaie. Un suivi apres 7 a 10 jours ainsi que les services d'une equipe specialisee en soin des plaies pourraient contribuer a reduire la frequence de ce type d'evenement.