Racial and ethnic minority groups, female sex, and tissue loss are associated with increased risk for hospital readmission following revascularization for chronic limb-threatening ischemia.

BACKGROUND

Unplanned hospital readmission following surgery for peripheral arterial disease is among the highest in all diagnosis-related groups. Although previous studies have examined readmissions in certain subgroups, such as for patients undergoing lower extremity bypass, few have examined longer term readmissions for those with the most severe form of peripheral arterial disease, chronic limb-threatening ischemia (CLTI). Among patients with CLTI undergoing revascularization, we sought to outline rates of readmission beyond 30 days up to 1 year and identify patient and procedural characteristics associated with readmission.

METHODS

We identified patients by Current Procedural Terminology codes from January 6, 2020, to May 25, 2022, and collected demographic, operative, and 1-year outcomes data. We used univariate and multivariable modeling to assess factors associated with hospital readmission.

RESULTS

Of the 247 patients who underwent intervention for CLTI, 130 patients (53%) were readmitted within 1 year, primarily for revascularization-related problems. The most common indications for readmission within 30 days and 1 year were wound infection and tissue breakdown (48.3% and 37.7%, respectively) and new rest pain or tissue loss (13.8% and 20.8%, respectively). The only cause of readmission considered nonmodifiable was undergoing a staged procedure. Overall, 96.6% and 96.9% of readmissions within 30 days and 1 year were potentially modifiable (ie, wound infection and tissue breakdown, new rest pain or tissue loss, graft thrombosis, sepsis, and myocardial infarction). After multivariable adjustment, racial and ethnic minority groups (odds ratio [OR], 2.6; P = .009), female sex (OR, 2.1; P = .031), and tissue loss as an indication (OR, 4.1; P = .0002) were associated with readmission within 30 days. At 1 year, only racial and ethnic minority status (OR, 2.6; P = .007) and a tissue loss indication (OR, 2.1; P = .011) were associated with readmissions. Patient age, comorbidity burden, area deprivation index, and intervention type (endovascular vs open) were not significantly associated with 30-day or 1-year readmissions. Racial and ethnic minority groups (P = .014), female sex (P = .05), acute kidney injury (P = .014), and index hospital length of stay (P = .009) were associated with multiple readmissions. Number of readmissions was not associated with risk of major limb amputation.

CONCLUSIONS

Postoperative readmission among patients with CLTI is high and occurs primarily for wound infections and new rest pain or tissue loss. Overall, the majority of readmissions were for potentially modifiable factors. Racial and ethnic minority groups and female patients undergoing revascularization for tissue loss are at greatest risk for readmissions. These data support the investigation of interventions targeting these high-risk populations.