Author + information
- Prakash Acharya,
- Sagar Ranka,
- Zubair Shah,
- Prince Sethi,
- Brianna Stack,
- Adam Alli,
- Zafar Ali and
- Kamal Gupta
Critical limb ischemia (CLI) is associated with significant morbidity and mortality. However, there is a dearth of data on six-month readmissions for CLI.
A secondary analysis of the Nationwide Readmissions Database for 2016 was conducted. Index admissions for CLI in the first six months were included and first re-admission for CLI within six months of discharge were considered for analysis.
There were 43,095 patients admitted with a primary diagnosis of CLI. At six months, the all-cause readmission rate was 48.3%. Readmission with CLI as the primary diagnosis was 10.62% and further analysis was performed on this group. Patients who were readmitted had a higher comorbidity burden (mean Elixhauser score 9.03 +7.37 vs 8.63+7.58, p=0.007). The adjusted risk of readmission was higher for patients presenting with limb ulceration [HR 1.22, CI (1.09-1.37), p=0.001] and gangrene [1.25, CI (1.12-1.38), p<0.001], compared to those with limb pain. History of smoking [HR 1.13, CI (1.03-1.25), p=0.014], coronary artery disease [HR 1.09, CI (1.01-1.19), p=0.03] and chronic kidney disease [HR 1.17, CI (1.05-1.30), p=0.004] was associated with increased adjusted risk of six-month readmission. The adjusted risk of readmission also differed according to the intervention performed during the index admission. Compared to stenting only, the adjusted risk was lower with bypass [HR 0.54, CI (0.47-0.62), p<0.001], bypass and stenting [HR 0.49, CI (0.41-0.56), p<0.001] and amputation [HR 0.72, CI (0.62-0.83), p<0.001].
Upon readmission, 81% of the patients underwent re-intervention, among which 12.7% required amputation. The adjusted risk of amputation on readmission was significantly lower among patients who had undergone bypass [HR 0.69, CI (0.55-0.88), p=0.002], bypass and stenting [HR 0.57, CI (0.47-0.70), p<0.001] and amputation [HR 0.48, CI (0.-0.97), p=0.03] compared to stenting on index admission.
The risk of six-month readmission in CLI patients is high and varies according to the symptoms, comorbidities, and procedures performed on index admission. Among readmitted patients, 8 in every 10 require re-intervention and one in every 8 require amputation.
Moderated Poster Contributions
Valvular Heart Disease and Vascular Medicine Moderated Poster Theater, Posters, Hall A
Saturday, March 28, 2020, 1:30 p.m.-1:40 p.m.
Session Title: On the Cutting Edge in Peripheral Artery Disease
Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1019-11
- 2020 American College of Cardiology Foundation