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.

Introduction: Unplanned hospital readmission following surgery for peripheral arterial disease (PAD) is among the highest in all diagnosis-related groups. While 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 PAD, 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 CPT codes from 1/6/2020 to 5/25/2022, and collected demographic, operative, and one-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 one year, primarily for revascularization-related problems. 130 patients (53%) were readmitted within one year. The most common indications for readmission within 30 days and one year were wound infection and tissue breakdown (48.3%, 37.7%) and new rest pain or tissue loss (13.8%, 20.8%). The only cause of readmission considered non-modifiable was staged procedure. Overall, 96.6% and 96.9% of readmissions within 30 days and 1 year were potentially modifiable (i.e., wound infection and tissue breakdown, new rest pain or tissue loss, graft thrombosis, sepsis, myocardial infarction, etc.). After multivariable adjustment, racial and ethnic minority groups (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 one-year, only racial and ethnic minority (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 and 1-year readmissions. Racial and ethnic minority groups (p=0.014), female sex (p=0.05), AKI (p=0.014), and index hospital LOS (p=0.009) 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 reasons. Racial and ethnic minority groups and female patients undergoing revascularization for tissue loss are at highest risk for readmissions. These data support the investigation of interventions targeting these high-risk populations.