Critical ischemia in the lower limbs: Frequent Readmissions show the magnitude of this problem

Readmissions at 6 months in patients with critical ischemia in the lower limbs occur in about 50% of all cases and most of them are unplanned.

This truly alarming number is cause for further concern when taking into account that only part of these readmissions are related to vascular problems. Many are caused by comorbidities such as infection or diabetes, often related to critical ischemia.

What this work does not say, ultimately, is that revascularization of the affected limb is not enough: physicians must ensure that all comorbidities are being properly treated.

In order to obtain the included data, 212,241 patients with critical ischemia in the lower limbs treated between 2009 and 2013 were analyzed.

At 30 days and 6 months, all-cause readmissions were 27.1% and 56.6%, respectively. Almost a fourth of all 30-day readmissions and almost half of all 6-month readmissions were unplanned.

A third of all unplanned readmissions were mainly due to causes related to critical ischemia or post-procedural complications, while the rest of them were a result of non-vascular causes such as sepsis or diabetes.

Patients who underwent surgical revascularization during index hospitalization were more prone to readmission than those revascularized endovascularly.

A more prolonged length of stay during index hospitalization was directly associated with the likelihood of readmission, which was, in turn, associated with higher mortality rates. A longer stay during index hospitalization could be explained simply as a result of patients who are more ill and, in turn, more likely to be readmitted. This should be a fairly simple way of predicting which patients require a closer follow-up in order to prevent unplanned readmissions.

Conclusion

Readmissions among patients with critical ischemia in the lower limbs are very frequent and most of them unplanned. A high number of demographic, clinical, and socioeconomic factors may play important roles in predicting these events.

Original title: Burden of Readmissions Among Patients with Critical Limb Ischemia.

Reference: Agarwal S et al. J Am Coll Cardiol. 2017; 69:1897-1908.

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