High Rate of Unplanned Admissions and Predictors Identified in CLI

The majority of readmissions for critical limb ischemia (CLI) at 30 days and 6 months are unplanned, and these are associated with a higher subsequent mortality rate, according to a study published March 6 in the Journal of the American College of Cardiology. The study will be presented as an oral abstract during ACC.17 in Washington, DC.

The study, led by Shikhar Agarwal, MD, MPH, FACC, et al., retrospectively analyzed data from 2009 --2013 from the states of Florida, New York, and California, which provide data on repeat admissions, obtained from the State Inpatient Database. A total of 284,189 admissions from 212,241 patients for the principal diagnosis of CLI were included in the study.

Results showed that at 30 days and 6 months, the rate of all-cause readmissions was 27.1 percent and 56.6 percent, while the rate of unplanned readmissions was 23.6 percent and 47.7 percent, respectively. The most frequent causes of unplanned readmission were miscellaneous, primary CLI-related causes, post-procedure complications, septicemia, and diabetes-related non-vascular causes.

Predictors of unplanned readmissions at 6 months were age, female sex, black or Hispanic race, prior amputation, a higher Charlson comorbidity index, need for rehabilitation facility or home health care services, as well as type of insurance (lower rate with private insurance). Only 33.6 percent of primary CLI admissions were discharged to home.

The authors conclude their findings have implications in relation to managing patient discharge and for policymakers in relation to payment reform based on length of stay or readmissions.

In an accompanying editorial, Mehdi H. Shishehbor, DO, MPH, PhD, FACC, and Herbert D. Aronow, MD, MPH, FACC, comment that most of the independent predictors of readmission are not modifiable, and that although “revascularization may be the most easily modifiable, a significant proportion of patients with CLI undergo major amputation” in the U.S. without undergoing a vascular evaluation in the preceding year. More robust data are needed, they add, to understand the factors that can reduce readmissions to inform clinical and policy decision making. 


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