CLI Patients Face High Readmission Rates

Patients with critical limb ischemia (CLI) have a high risk of readmission, with most of the readmissions unplanned, according to a new study.

Researchers at Geisinger Medical Center, Rutgers New Jersey Medical School, and other institutions conducted a study that analyzed all adult hospitalizations with a diagnosis code for CLI using state inpatient databases from Florida (2009 to 2013), New York (2010 to 2013), and California (2009 to 2011), in order to determine the incidence of readmission and factors affecting readmission. In all, 695,782 admissions from 212,241 patients were analyzed.

The results showed that 284,189 of the total patient admissions were primary CLI admissions. At 30 days and at six months, all-cause readmission rates for the patients were 27.1% and 56.6%, respectively, and the rates of unplanned readmissions were 23.6% and 47.7%. Age, female sex, black or hispanic race, prior amputation, Charlson comorbidity index, and need for home health care or rehabilitation facility upon discharge were major predictors of six-month unplanned readmissions.

When compared with patients with Medicaid, the uninsured, and Medicare populations, those covered by private insurance were least likely to have a readmission. There was also an inverse association for travel time to the hospital with six-month unplanned readmission rates, seen in all of the subgroups. Another direct association of six-month unplanned readmission identified was length of stay during index hospitalization. The study was published on April 18, 2017, in Journal of the American College of Cardiology (JACC).

“Readmissions constitute a major health care burden among critical limb ischemia patients, the majority of them being unplanned readmissions,” concluded lead author Shikhar Agarwal, MD, MPH, of Geisinger Medical Center, and colleagues. “Several demographic, clinical, and socioeconomic factors play important roles in predicting readmissions.”

CLI is a severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow. It is a serious form of peripheral arterial disease (PAD), but less common than claudication. PAD is caused by atherosclerosis, and results in severe pain in the feet or toes, even while resting, due to poor circulation. Complications include sores and wounds that will not heal in the legs and feet that if left untreated can result in amputation of the affected limb.