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Hospital readmission rates high in CLI
Among patients hospitalized for critical limb ischemia, more than half were readmitted 6 months later, according to published findings.
Using information from State Inpatient Databases from California, Florida and New York, researchers determined that rates of all-cause readmission among patients hospitalized with a primary diagnosis of CLI were 27.1% at 30 days and 56.6% at 6 months.
Moreover, unplanned hospital readmission was common, with rates of 23.6% at 30 days and 47.7% at 6 months. CLI was the top cause for unplanned readmission, followed by postprocedural complications, septicemia, and diabetes-related and nonvascular causes.
Predictors of readmission
The researchers identified several major predictors of unplanned hospital readmission at 6 months, including older age, female sex, black or Hispanic race, prior amputation, higher Charlson comorbidity index and need for home health care or rehabilitation facility upon discharge. Readmission was also less likely to occur among patients with private insurance vs. Medicaid, no insurance or Medicare.
Additionally, incidence of readmission increased with longer length of stay during the index hospital admission (OR for log-transformed length of stay = 2.39; 99% CI, 2.31-2.47).
The researchers also merged data from the State Inpatient Databases with available data on hospital characteristics from the American Hospital Association. In their analyses, they found that urban hospitals, compared with rural hospitals, had significantly higher readmission rates at 30 days and 6 months (P < .001 for both), as did teaching hospitals compared with nonteaching hospitals (P < .001 for both).
On adjusted analysis, the rate of unplanned readmissions at 6 months was also likely to be increased in hospitals with higher turnover.
In a subgroup analysis of patients living in Florida and New York, the researchers evaluated the effect of travel time to the hospital on readmission rates. At 6 months, unplanned readmission rates were 50.2% for patients living 20 minutes or less from the hospital, 46.9% for those living 20 to 40 minutes from the hospital, 43.2% for those living 40 to 60 minutes from the hospital and 38.1% for those living more than 60 minutes from the hospital.
“These findings have implications for how providers manage patient discharge as well as for policymakers, as payment reforms are implemented based on [length of stay] or readmissions,” the researchers wrote.
Treatment complex
Cardiology Today Next Gen Innovator, Mehdi H. Shishehbor, DO, MPH, of the Heart and Vascular Institute at Cleveland Clinic, and Herbert D. Aronow, MD, MPH, of the Warren Alpert Medical School of Brown University, in an accompanying editorial comment underscored the significant cost of hospital readmissions as well as their use as a quality metric, noting that reducing the rate of readmissions in patients with CLI is important.
However, Shishehbor and Aronow acknowledged barriers to achieving this reduction, such as some centers lacking all components necessary for optimal care, including wound care, infectious disease and vascular specialists. Advances in areas such as telemedicine, for example, could help, they noted.
“Nevertheless, for the foreseeable future, CLI treatment will remain complex and we must better understand all involved issues before assigning and publicly reporting readmission as a quality metric or basing reimbursement decisions on associated readmission rates,” Shishehbor and Aronow wrote. “In short, we must decide whether CLI readmission is a necessary or unnecessary evil in the care continuum of the CLI patient.” – by Melissa Foster
Disclosure: The researchers, Aronow and Shishehbor report no relevant financial disclosures.