Ahmed Kayssi1, Charles de Mestral1, Thomas L Forbes1, Graham Roche-Nagle2. 1. Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. 2. Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: graham.roche-nagle@uhn.ca.
Abstract
OBJECTIVE: To describe the factors associated with early (≤30 days) and late (31-365 days) hospital readmissions after lower extremity amputations in Canada. METHODS: A retrospective cohort study was carried out for all Canadian adults who underwent elective lower extremity amputations in the years 2006 to 2008 for nontraumatic indications. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada, with the exception of the Province of Quebec. RESULTS: During the study period, 3823 patients underwent lower limb amputations (major amputations = 95%) and 2116 were readmitted at least once (55.4%). Of those patients, 1112 (29.1%) were readmitted within 30 days (mean = 5.0 ± 8.3 days after discharge) and 1004 (26.3%) were readmitted between 31 and 365 days (mean = 151.4 ± 95.9 days after discharge). Stump complications accounted for 13% and 10% of early and late readmissions, respectively. Stump revision surgery was performed in 301 readmitted patients (7.9%). Predictors of early readmission included amputation by a vascular surgeon (odds ratio, 1.6; 95% confidence interval, 1.3-1.9), female sex (odds ratio, 1.2; 95% confidence interval, 1.1-1.5), and a short (<7 day) admission (odds ratio, 1.7; 95% confidence interval, 1.4-2.1). Predictors of late readmission included a longer (≥7 days) admission (odds ratio, 1.5; 95% confidence interval, 1.2-1.8), discharge to a long-term care facility (odds ratio, 3.3; 95% confidence interval, 2.7-3.9), and home discharge with community support (odds ratio, 2.3; 95% confidence interval, 1.8-2.9). CONCLUSIONS: Half of patients who underwent lower extremity amputations were readmitted to the hospital within 1 year. Markers of patient dependence (long hospitalization, discharge to long-term care facility) predict late readmission.
OBJECTIVE: To describe the factors associated with early (≤30 days) and late (31-365 days) hospital readmissions after lower extremity amputations in Canada. METHODS: A retrospective cohort study was carried out for all Canadian adults who underwent elective lower extremity amputations in the years 2006 to 2008 for nontraumatic indications. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada, with the exception of the Province of Quebec. RESULTS: During the study period, 3823 patients underwent lower limb amputations (major amputations = 95%) and 2116 were readmitted at least once (55.4%). Of those patients, 1112 (29.1%) were readmitted within 30 days (mean = 5.0 ± 8.3 days after discharge) and 1004 (26.3%) were readmitted between 31 and 365 days (mean = 151.4 ± 95.9 days after discharge). Stump complications accounted for 13% and 10% of early and late readmissions, respectively. Stump revision surgery was performed in 301 readmitted patients (7.9%). Predictors of early readmission included amputation by a vascular surgeon (odds ratio, 1.6; 95% confidence interval, 1.3-1.9), female sex (odds ratio, 1.2; 95% confidence interval, 1.1-1.5), and a short (<7 day) admission (odds ratio, 1.7; 95% confidence interval, 1.4-2.1). Predictors of late readmission included a longer (≥7 days) admission (odds ratio, 1.5; 95% confidence interval, 1.2-1.8), discharge to a long-term care facility (odds ratio, 3.3; 95% confidence interval, 2.7-3.9), and home discharge with community support (odds ratio, 2.3; 95% confidence interval, 1.8-2.9). CONCLUSIONS: Half of patients who underwent lower extremity amputations were readmitted to the hospital within 1 year. Markers of patient dependence (long hospitalization, discharge to long-term care facility) predict late readmission.
Authors: Mohamad A Hussain; Mohammed Al-Omran; Konrad Salata; Atul Sivaswamy; Thomas L Forbes; Naveed Sattar; Badr Aljabri; Ahmed Kayssi; Subodh Verma; Charles de Mestral Journal: CMAJ Date: 2019-09-03 Impact factor: 8.262
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