Trends in mortality, readmissions, and complications after endovascular and open infrainguinal revascularization

Habib Khoury; Ricardo Rosales Morales; Yas Sanaiha; Sarah Rudasill; Rakin Jaman; Hugh Gelabert; Peyman Benharash

doi:10.1016/j.surg.2019.03.019

Trends in mortality, readmissions, and complications after endovascular and open infrainguinal revascularization

Surgery. 2019 Jun;165(6):1222-1227. doi: 10.1016/j.surg.2019.03.019. Epub 2019 May 6.

Authors

Habib Khoury¹, Ricardo Rosales Morales¹, Yas Sanaiha², Sarah Rudasill¹, Rakin Jaman¹, Hugh Gelabert³, Peyman Benharash⁴

Affiliations

¹ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, CA.
² Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, CA; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, CA.
³ Division of Vascular Surgery, University of California Los Angeles, Los Angeles, CA.
⁴ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, CA; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, CA. Electronic address: pbenharash@mednet.ucla.edu.

PMID: 31072666
DOI: 10.1016/j.surg.2019.03.019

Abstract

Background: Although short-term outcomes of endovascular and open infrainguinal revascularization in patients with peripheral arterial disease have been previously reported, 30-day readmission and resource utilization after these procedures remain unknown.

Methods: We used the 2010-2014 Nationwide Readmissions Database and the International Classification of Diseases, Ninth Edition, to identify patients with peripheral arterial disease undergoing either in-hospital endovascular or open infrainguinal revascularization.

Results: Of an estimated 574,201 hospitalized patients treated for peripheral arterial disease, 308,056 and 266,145 underwent lower limb endovascular and open infrainguinal revascularization, respectively. Compared with patients who underwent open revascularization, endovascular patients were more commonly female (44.8% vs 36.7%, P < .001) and older (69.5 vs 67.2 years, P < .001). Moreover, they had higher rates of 30-day readmission (15.6% vs 13.5%, P < .001), in-hospital complications (22.3% vs 20.9%, P < .001), and in-hospital index mortality (2.1% vs 1.8%, P < .001). In contrast, risk-adjusted multivariable analysis found open revascularization to be independently associated with increased odds of 30-day readmission (odds ratio, 1.13; 95% confidence interval 1.10-1.16), index complications (odds ratio, 1.23; 95% confidence interval 1.20-1.27), and mortality (odds ratio, 1.26; 95% confidence interval 1.16-1.36) compared with those who underwent endovascular revascularization. Trend analysis revealed an overall decrease in the utilization of both endovascular and open revascularization procedures in the inpatient setting.

Conclusion: Despite lower rates of adverse events compared to endovascular, open infrainguinal revascularization is independently associated with increased risk of short-term readmission, complications, and mortality. These findings should be considered in the selection of appropriate surgical therapy for lower extremity arterial occlusive disease.

MeSH terms

Adult
Aged
Aged, 80 and over
Databases, Factual
Endovascular Procedures* / adverse effects
Female
Hospital Mortality
Humans
Logistic Models
Lower Extremity / blood supply
Lower Extremity / surgery*
Male
Middle Aged
Multivariate Analysis
Patient Readmission / statistics & numerical data*
Peripheral Arterial Disease / mortality
Peripheral Arterial Disease / surgery*
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Retrospective Studies
Risk Adjustment
Treatment Outcome
United States
Vascular Grafting / adverse effects
Vascular Grafting / methods*