Logo image
Back
Incidence, Risk Factors, and Causes for Thirty-Day Unplanned Readmissions Following Primary Lower-Extremity Amputation in Patients with Diabetes
Journal article   Peer reviewed

Incidence, Risk Factors, and Causes for Thirty-Day Unplanned Readmissions Following Primary Lower-Extremity Amputation in Patients with Diabetes

Zachary Ries, Chamnanni Rungprai, Bethany Harpole, Ong-Art Phruetthiphat, Yubo Gao, Andrew Pugely and Phinit Phisitkul
Journal of bone and joint surgery. American volume, Vol.97(21), pp.1774-1780
11/04/2015
DOI: 10.2106/JBJS.O.00449
PMID: 26537165

View Online

Abstract

The Centers for Medicare & Medicaid Services targeted thirty-day readmissions as a quality-of-care measure. Hospitals can be penalized on unplanned readmissions. Given the frequency of amputation in diabetic patients and our changing health-care system, the purpose of this study was to determine the incidence, risk factors, and causes for unplanned thirty-day readmissions following primary lower-extremity amputation in diabetic patients. Patients with a diagnosis of diabetes undergoing primary lower-extremity amputation between 2002 and 2013 were retrospectively identified in a single-center patient database. Chart review determined patient factors including comorbidities, hemoglobin A1c level, amputation level, and demographic characteristics. Patients were divided into groups with and without unplanned readmission within thirty days postoperatively. Univariate and multivariate logistic regression analyses were used to compare cohorts and to identify variables associated with readmission. Overall, forty-six (10.5%) of 439 diabetic patients undergoing primary lower-extremity amputation had an unplanned thirty-day readmission. The top reason for readmission was a major surgical event requiring reoperation (37.0%), followed by medical events (28.3%) and minor surgical events (28.3%). In the univariate analysis, discharge on antibiotics (p = 0.002), smoking (p = 0.003), chronic kidney disease (p = 0.002), peripheral vascular disease (p = 0.002), and higher Charlson Comorbidity Index (p = 0.001) were each associated with readmission. In the multivariate analysis, diagnosis of gangrene (odds ratio [OR], 2.95 [95% confidence interval (95% CI), 1.37 to 6.35]), discharge on antibiotics (OR, 4.48 [95% CI, 1.71 to 11.74]), smoking (OR, 3.22 [95% CI, 1.40 to 7.36]), chronic kidney disease (OR, 2.82 [95% CI, 1.30 to 6.15]), and peripheral vascular disease (OR, 2.47 [95% CI, 1.08 to 5.67]) were independently associated with readmission. Thirty-day readmission rates following primary lower-extremity amputation in patients with diabetes were high at >10%. Both medical and surgical complications, many of which were unavoidable, contributed to readmission. Quality-reporting metrics should include these risk factors to avoid undeservedly penalizing surgeons and hospitals caring for this patient population. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
 Reoperation Patient Readmission Amputation - adverse effects Humans Middle Aged Risk Factors Male Diabetes Complications - complications Incidence Lower Extremity Adult Female Aged Diabetes Complications - surgery Retrospective Studies

Details

Metrics

147 Record Views
31 Times Cited - Web of Science
Logo image