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Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.

Publication ,  Journal Article
Flink, BJ; Long, CA; Duwayri, Y; Brewster, LP; Veeraswamy, R; Gallagher, K; Arya, S
Published in: J Vasc Surg
June 2016

OBJECTIVE: Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. METHODS: Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. RESULTS: Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P < .001) overall (Procedure subtypes: abdominal aortic aneurysm [10.1% vs 7.7%; P < .001], thoracic aortic aneurysm [14.1% vs 13.5%; P = .8], and thoracoabdominal aortic aneurysm [14.8% vs 10%; P = .051]). The higher odds of readmission in women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P < .001), but discharge to a nonhome facility was not a significant predictor of unplanned readmission. Upon stratification by discharge destination, the higher odds of readmissions in women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. CONCLUSIONS: Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women undergoing aortic procedures to decrease readmissions.

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Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

June 2016

Volume

63

Issue

6

Start / End Page

1496 / 1504.e1

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Patient Discharge
 

Citation

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Flink, B. J., Long, C. A., Duwayri, Y., Brewster, L. P., Veeraswamy, R., Gallagher, K., & Arya, S. (2016). Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. J Vasc Surg, 63(6), 1496-1504.e1. https://doi.org/10.1016/j.jvs.2015.12.054
Flink, Benjamin J., Chandler A. Long, Yazan Duwayri, Luke P. Brewster, Ravi Veeraswamy, Katherine Gallagher, and Shipra Arya. “Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.J Vasc Surg 63, no. 6 (June 2016): 1496-1504.e1. https://doi.org/10.1016/j.jvs.2015.12.054.
Flink BJ, Long CA, Duwayri Y, Brewster LP, Veeraswamy R, Gallagher K, et al. Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. J Vasc Surg. 2016 Jun;63(6):1496-1504.e1.
Flink, Benjamin J., et al. “Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.J Vasc Surg, vol. 63, no. 6, June 2016, pp. 1496-1504.e1. Pubmed, doi:10.1016/j.jvs.2015.12.054.
Flink BJ, Long CA, Duwayri Y, Brewster LP, Veeraswamy R, Gallagher K, Arya S. Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. J Vasc Surg. 2016 Jun;63(6):1496-1504.e1.
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

June 2016

Volume

63

Issue

6

Start / End Page

1496 / 1504.e1

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • United States
  • Treatment Outcome
  • Time Factors
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Patient Discharge