Burden and causes of readmissions following initial discharge after aortic syndromes

D’Oria, Mario; Sen, Indrani; Day, Courtney N.; Mandrekar, Jay; Weiss, Salome; Bower, Thomas C.; Oderich, Gustavo S.; Goodney, Philip P.; DeMartino, Randall R. (2021). Burden and causes of readmissions following initial discharge after aortic syndromes. Journal of vascular surgery, 73(3), 836-843.e3. Elsevier 10.1016/j.jvs.2020.05.080

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Abstract

Introduction: Aortic syndromes (AS), including aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU), carry significant morbidity and mortality; little data exist regarding burden and causes of related rehospitalizations following initial discharge.

Methods: The study was conducted using the Rochester Epidemiology Project (REP). All adult residents (age≥18 years) with an incident diagnosis of AD/IMH/PAU (1995-2015) were identified from the REP using the International Classification of Disease (ICD), 9th and 10th revision, codes and Hospital Adaptation of the ICD, 2nd edition, codes. Assessment of any-cause (aortic+cardiovascular), aortic-related, or cardiovascular-related readmissions was determined following date of hospital discharge or diagnosis date (i.e. the index event).

Results: A total of 117 patients out of 130 cases of AD/IMH/PAU included in the initial study population survived the index event and were evaluated. The median age of diagnosis was 74 years and 70 (60%) were male. A total of 79 patients (68%) experienced at least one readmission. The median time to first any-cause, cardiovascular and aortic readmission was 143, 861 and 171 days, respectively. The cumulative incidence of any-cause readmissions at 2, 4 and 10 years was 45%, 55% and 69%, respectively. The cumulative incidence of cardiovascular readmissions at 2, 4 and 10 years was 15%, 20% and 28%, respectively. The cumulative incidence of aortic readmissions at 2, 4 and 10 years was 38%, 46% and 59%, respectively. Overall survival for the entire cohort at 2, 4 and 10 years was 84%, 75% and 50%, respectively.

Conclusion: Readmissions following initial discharge after diagnosis of AS are common and not different across specific disease types. While aortic-related rehospitalization occur in more than half of patients but tend to be earlier, cardiovascular-related rehospitalizations tend to happen later in about one third of subjects. This may suggest the need for early follow-up focused on aortic complications while later follow-up should address cardiovascular events.

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