A. Najafian1, S. Selvarajah1, E. B. Schneider1, M. B. Malas2, B. Ehlert3, K. C. Orion3, A. H. Haider1, C. J. Abularrage3 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 3Johns Hopkins University School Of Medicine,Division Of Vascular Surgery And Endovascular Therapy, Department Of Surgery,Baltimore, MD, USA
Introduction: Readmission negatively affects reimbursement and increases both morbidity and mortality. Lower extremity bypass (LEB) has been shown to be associated with readmission. This study aimed to compare 30-day unplanned readmission after LEB between diabetics and non-diabetics.
Methods: Patients undergoing LEB in the 2011-12 ACS-NSQIP database were divided into 3 groups: non-diabetics (non-DM), non-insulin-dependent diabetics (NIDDM) and insulin dependent diabetics (IDDM). Unplanned readmission was compared and multivariate logistic regression was used to evaluate the influence of diabetes status on 30-day readmission.
Results: A total of 9207 patients (5155 (56%) non-DM, 1690 (18%) NIDDM and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 (16%) patients. IDDM had significantly higher crude postoperative complication (30% non-DM, 36% NIDDM vs. 43%, P<0.001) and unplanned readmission rates (14% non-DM, 16% NIDDM vs. 20%, P<0.001). Concomitant cardiac disease significantly modified the association between diabetes and unplanned readmission. On multivariable analysis, IDDM was an independent predictor of unplanned readmission in the absence of cardiac disease (OR=1.21; 95% CI [1.01-1.44]; P=0.03). However, this association did not remain significant in the presence of cardiac disease (OR=1.16; 95% CI [0.88-1.53]; P=0.28). Subgroup analysis of IDDM patients revealed that regardless of cardiac status, postoperative complications were the strongest independent predictors of unplanned readmission. In IDDM without concomitant cardiac disease, the only preoperative independent predictors of unplanned readmission were dialysis (OR=1.57; 95% CI [1.08-2.28]; P=0.01) and anemia (OR=1.51; 95% CI [1.09-2.08]; P=0.01).
Conclusion: While unplanned readmission after LEB was more common among diabetics, only IDDM in the absence of cardiac disease was independently associated with unplanned readmission. In IDDM patients without cardiac disease, dialysis dependence and anemia significantly increased the likelihood of unplanned readmission. Regardless of cardiac status, postoperative complications were strongly associated with readmission.