Assessment of Potentially Preventable Hospital Readmissions After Vascular Surgery.

Abstract

Post-surgical readmissions are common, costly, and widely used as a marker of healthcare quality, with particularly high rates following vascular surgery. Despite this burden, the proportion of readmissions that are potentially preventable remains unclear, especially in this high-risk population. The objective of this study was to quantify the burden of potentially preventable readmissions after major vascular surgery and identify patient- and procedure-level factors associated with their occurrence. This retrospective cohort study used the 2016-2022 National Readmissions Database to evaluate a weighted sample of 544,404 adult inpatient hospitalizations for 4 common major vascular surgical procedures: carotid endarterectomy, open abdominal aortic aneurysm repair, lower extremity peripheral arterial bypass, and endovascular abdominal aortic aneurysm repair. Ninety-day readmission rates were assessed, including potentially preventable readmissions (PPRs) defined by the Agency for Healthcare Research and Quality as ambulatory care sensitive conditions, as well as superficial surgical site infection, acute kidney injury, and aspiration pneumonitis. Multivariable logistic regression was used to identify factors associated with PPRs. Among an estimated 544,404 patients undergoing major vascular surgery, 20.4% (110,965/544,404) experienced a 90-day readmission, 17% (19,013/110,965) of which were classified as a PPR. PPR rates varied by procedure, ranging from 2.4% after carotid endarterectomy to 6.2% after lower extremity bypass, and were higher among lower-income and publicly insured patients. On multivariable analysis, older age (OR 1.22 per decade), female sex (OR 1.23), complicated diabetes (OR 2.40), chronic kidney disease (OR 1.70), and congestive heart failure (OR 2.14) were independently associated with increased odds of PPR, whereas higher household income was associated with lower odds. This study suggests that nearly one in five readmissions after vascular surgery are potentially preventable. Alongside optimization of inpatient care, improved access to ambulatory and transitional care may represent an important opportunity to reduce avoidable readmissions in this population.