1. Impact of patient factors and procedure on readmission after aortic dissection admission in the states of Florida and New York.
- Author
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Weiss S, Rojas RL, Habermann EB, Moriarty JP, Borah BJ, and DeMartino RR
- Subjects
- Administrative Claims, Healthcare statistics & numerical data, Aged, Aged, 80 and over, Aortic Dissection complications, Aortic Dissection epidemiology, Aortic Dissection mortality, Comorbidity, Female, Florida epidemiology, Geography, Humans, Male, Middle Aged, New York epidemiology, Odds Ratio, Postoperative Complications etiology, Postoperative Complications therapy, Retrospective Studies, Risk Factors, Socioeconomic Factors, Vascular Surgical Procedures methods, Vascular Surgical Procedures statistics & numerical data, Aortic Dissection surgery, Patient Readmission statistics & numerical data, Postoperative Complications epidemiology, Vascular Surgical Procedures adverse effects
- Abstract
Background: Readmissions after aortic dissection (AD) admission are not well described. Using state-based administrative claims data, we sought to define readmission rates after AD and to identify factors associated with them., Methods: State Inpatient Databases for Florida (2007-2012) and New York (2008-2012) were queried for AD index admissions. Admissions were stratified by initial treatment strategy: type A open surgery repair (TAOR), type B open surgery repair (TBOR), thoracic endovascular aortic repair (TEVAR), or medical management (MM). All-cause readmission rates were calculated at 30 days, 90 days, and 2 years. Logistic regression was used to identify factors associated with readmission at each time point for all type A admissions (TAOR) or type B admissions (TBOR, TEVAR, MM)., Results: We identified 4670 patients with an AD index admission. Treatment was with TAOR in 1031 (22%), TBOR in 761 (16%), TEVAR in 412 (9%), and MM in 2466 (53%). Patients were predominantly male (59.4%) and white (61.9%), with a median age of 66 years. Overall mortality during AD index admission was 14.8% (TAOR, 15.8%; TBOR, 17.1%; TEVAR, 9.0%; MM, 14.7%; P = .002 across all groups). All-cause readmission rates were similar across treatment groups at 30 days (9.6%-11%; P = .56), 90 days (15.2%-20%; P = .26), and 2 years (49.2%-54.4%; P = .15). Higher income quartile (vs lowest) was associated with lower odds of early readmission (at 30 days and 90 days) after type B admissions but not after type A admissions. At 2 years, self-pay (vs Medicare) was associated with lower odds of readmission in both type A and type B admissions, whereas higher comorbidity count and black race (vs white) were associated with higher odds of readmission. TEVAR (vs MM) was also associated with higher odds of readmission. Cardiovascular disease was the most common cause for readmission at all time points. Emergency department readmission counts were highest after MM admissions, and ambulatory surgical admissions were highest after TBOR. Both TEVAR and MM initial costs were lower than TAOR and TBOR costs, but at 2 years, costs remained significantly lower only for MM., Conclusions: In-state 30-day, 90-day, and 2-year readmission rates after AD were not associated with initial treatment type. Two-year readmissions are common. Strategies to target socioeconomic, race, and geographic factors may reduce variations in readmission patterns after AD admission., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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