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    The Relevance of Readmissions after Common IR Procedures: Readmission Rates and Association with Early Mortality

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    Authors
    Sarwar, Ammar
    Zhou, Lujia
    Chakrala, Nihara
    Brook, Olga R.
    Weinstein, Jeffrey L.
    Rosen, Max P.
    Ahmed, Muneeb
    UMass Chan Affiliations
    Department of Radiology
    Document Type
    Journal Article
    Publication Date
    2017-05-01
    Keywords
    Radiology
    
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    Link to Full Text
    https://doi.org/10.1016/j.jvir.2017.01.008
    Abstract
    PURPOSE: To determine all-cause readmission rates for 12 IR procedures and association of time to readmission with risk-adjusted 90-day mortality. MATERIALS AND METHODS: Patients discharged after 12 inpatient IR procedures at a tertiary-care hospital between June 2008 and May 2013 (N = 4,163) were categorized as no readmission (n = 1,479; 40.5%) or readmission between 0 and 7 (n = 379; 10.4%), 8 and 30 (n = 650; 17.8%), 31 and 60 (n = 378; 10.3%), 61 and 90 (n = 169; 4.6%), or 91 and 180 days (n = 280; 7.7%). Readmission rate >/= 15% was considered high based on published national readmission rates for procedures. Risk-adjusted 90-day mortality for each interval was calculated for transjugular intrahepatic portosystemic shunt (TIPS), transjugular and percutaneous liver biopsy (TJLB, PLB), ports, inferior vena cava (IVC) filter, lower extremity angioplasty (LEA), arteriovenous fistulagrams, vascular embolization (VE), percutaneous cholecystostomy (PC), percutaneous transhepatic biliary drainage (PTBD), primary urinary drainage, and feeding tube placement. Covariates included age, sex, race, insurance status, and Charlson Comorbidity Index. RESULTS: All procedures had high 30-day readmission rates (15%-50.5%). Readmissions were highest for ports (50.5%), TJLB (43.4%), PTBD (38.5%), PC (31.9%), and TIPS (31.3%). Readmissions occurred most frequently 8-30 days after discharge for all procedures except VE (31-60 d; 10.6%), PC (31-60 d; 23.4%), and LEA (91-180 d; 15.1%). On multivariate analysis, 30-day readmissions for LEA (AOR 3.19; 95% CI, 1.2-8.2; P = .02), VE (AOR 10.01; 95% CI, 3.1-32.9; P < .001), IVC filter (AOR 2.98; 95% CI, 1.3-6.9; P = .01), PLB (AOR 2.86; 95% CI, 1.71-4.79; P < .001), and PCN (AOR 3.09; 95% CI, 1.29-7.37; P = .01) were associated with 90-day mortality. CONCLUSIONS: Inpatient IR procedures have high 30-day all-cause readmission rates, which can be associated with increased 90-day mortality. Further evaluation to determine preventable causes for readmission may impact 90-day mortality.
    Source
    J Vasc Interv Radiol. 2017 May;28(5):629-636. doi: 10.1016/j.jvir.2017.01.008. Epub 2017 Mar 11. Link to article on publisher's site
    DOI
    10.1016/j.jvir.2017.01.008
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48118
    PubMed ID
    28291716
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jvir.2017.01.008
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