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Unplanned Readmissions After Open Thoracoabdominal Aortic Aneurysm Repair.
Wu, Darrell; Price, Matt D; Amarasekara, Hiruni S; Green, Susan Y; Woodside, Sandra J; Tullos, Adam; Zhang, Qianzi; Coselli, Joseph S; LeMaire, Scott A.
Afiliação
  • Wu D; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
  • Price MD; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Amarasekara HS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Green SY; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Woodside SJ; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Tullos A; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Zhang Q; Surgical Research Core, Baylor College of Medicine, Houston, Texas.
  • Coselli JS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Surgical Research Core
  • LeMaire SA; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Surgical Research Core
Ann Thorac Surg ; 105(1): 228-234, 2018 Jan.
Article em En | MEDLINE | ID: mdl-29157740
BACKGROUND: Although reducing the incidence of unplanned readmission after thoracoabdominal aortic aneurysm (TAAA) repair represents an important opportunity to improve outcomes, predictors of readmissions are not known. We sought to characterize and identify factors associated with unplanned readmission after discharge in survivors of open TAAA repair. METHODS: Through prospective phone contact and retrospective record review, we determined the frequency and characteristics of unplanned readmissions within 30 days of discharge in 363 patients who were discharged after open TAAA repair. We used univariate and multivariable analyses to identify factors associated with readmission. RESULTS: There were 44 unplanned readmissions in 40 patients (11%). After readmission, 11 patients underwent operations, and 17 underwent nonsurgical procedures, the most common of which was thoracentesis (n = 9). Readmitted patients tended to have lower preoperative estimated glomerular filtration rates (p = 0.045), higher frequencies of preoperative sleep apnea (p = 0.009) and postoperative pulmonary (p = 0.04) and infection (p = 0.02) complications, and longer hospital stays (p = 0.01) than patients without readmissions. Patient age, urgency of operation, and extent of TAAA repair were similar in patients with and without readmissions. Multivariable analysis identified sleep apnea (relative risk ratio [RRR] 3.21, 95% confidence interval [CI]: 1.51 to 6.82, p = 0.002), postoperative infection (RRR 4.34, 95% CI: 1.32 to 14.25, p = 0.02), renal failure necessitating dialysis (RRR 3.14, 95% CI: 1.04 to 9.46, p = 0.04), and visceral artery stenting (RRR 2.43, 95% CI: 1.09 to 5.44, p = 0.03) as significant predictors of readmission. CONCLUSIONS: Patients with renal dysfunction, sleep apnea, or postoperative infection were particularly likely to be readmitted; optimizing the management of these factors may reduce early readmission after TAAA repair.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Aneurisma da Aorta Torácica Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Thorac Surg Ano de publicação: 2018 Tipo de documento: Article País de publicação: Holanda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Aneurisma da Aorta Torácica Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Thorac Surg Ano de publicação: 2018 Tipo de documento: Article País de publicação: Holanda