Background
Unplanned hospital readmissions after surgical operations are considered a marker
for suboptimal care during index hospitalizations and are associated with poor patient
outcomes and increased healthcare resource utilization. Patients undergoing lower
extremity bypass (LEB) operations for severe peripheral arterial disease (PAD) have
one of the highest readmission rates, among all the vascular and nonvascular surgical
operations. This review is meant to evaluate the impact of pre-existing comorbidities
(diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), congestive
heart failure (CHF), hypertension (HTN), and coronary artery disease (CAD))—on the
30-day readmission rates among patients who underwent LEB for severe PAD.
Methods
The review protocol was registered to the PROSPERO database (CRD42021261067). A systematic review of the English literature was performed using PubMed, Scopus,
and the Cochrane Library databases from inception till April 2022. The review was
based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)
guidelines and included only studies reporting on 30-day readmission following LEB
for occlusive PAD. The quality of evidence was assessed using the Grading of Recommendations,
Assessment, Development, and Evaluations (GRADE) approach and was reported as high,
moderate, or low. The risk of bias was evaluated utilizing the Risk of Bias in Nonrandomized
Studies - of Interventions (ROBINS-I) tool. A pooled odds ratio (OR) for each study
was computed, and a P-value of <0.05 was designated as statistically significant. Interstudy heterogeneity
was evaluated by Q-metric and quantified using Higgins I2 statistics.
Results
Five studies reported data on 30-day readmission after LEB for occlusive PAD. A total
of 19,739 patients were included. Readmission occurred among 3,559 (18%) patients.
DM and COPD were reported by all 5 selected studies, and CHF and HTN were reported
by 4 studies. CAD was least reported among the selected 5 pre-existing conditions,
with only 2 studies mentioning it. HTN (OR, 1.35; 95% confidence interval (CI), 1.10–1.64;
P ≤ 0.001; I2 = 52.20%), DM (OR, 1.52; 95% CI, 1.30–1.79; P ≤ 0.001; I2 = 74.51%), and CHF (OR, 1.85; 95% CI, 1.51–2.25; P ≤ 0.001; I2 = 50.48%) were all found to be associated with an increased risk of 30-day readmission,
while the presence of COPD (OR, 1.16; 95% CI, 0.98–1.36; P = 0.09; I2 = 61.93%) and CAD (OR, 1.30; 95% CI, 0.94–1.78; P = 0.11; I2 = 51.01%) was not associated with early readmission on meta-analysis of the available
studies.
Conclusions
The pre-existing comorbidities HTN, DM, and CHF increase the risk of 30-day readmission
after LEB for occlusive PAD. The identification of these risk factors can help stratify
the patients and further guide in understanding the variety of factors that contribute
in hospital readmissions.
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Article info
Publication history
Published online: December 19, 2022
Accepted:
December 11,
2022
Received:
July 19,
2022
Footnotes
Author contributions: AZ: Conception and Design, Analysis and Interpretation, Data Collection, Write-up and Revision, Approval of Manuscript, Statistical Analysis. MA: Data Collection, Write-up and Revision, Approval of Manuscript. OC: Data Collection, Write-up and Revision, Approval of Manuscript. RMH: Analysis and Interpretation, Write-up and Revision, Approval of Manuscript. AP: Analysis and Interpretation, Write-up and Revision, Approval of Manuscript. FA: Conception and Design, Analysis and Interpretation, Write-up and Revision, Approval of Manuscript.
Identification
Copyright
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