The Revolving Door of Hospital Admissions for Diabetic Foot Infections In The United States

Author(s):
Gabriel Ruiz; Joshua Parreco; Georgia Vasileiou; Howard Lieberman; Rishi Rattan

Background:

The Centers for Medicare and Medicaid Services (CMS) has recently been reducing hospital compensation for readmissions. The purpose of this study was to evaluate the risk factors for hospital readmissions for patients with diabetes, peripheral circulatory disorders, and infected wounds including readmissions to different hospitals across the United States.

Hypothesis:

It was hypothesized that limb salvage procedures would be associated with an increased risk for repeated hospital readmission in patients with diabetes, peripheral circulatory disorders, and infected wounds.

Methods:

The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged 18 years or older with a diagnosis code for diabetes with peripheral circulatory disorders, and a lower extremity wound. Univariable analysis was performed using 45 patient and hospital variables for the outcomes of readmission within one year and more than one readmission. Multivariable logistic regression was performed for each outcome using all significant (p<0.05) variables on univariable analysis. Results were weighted for national estimates.

Results:

There were 321,465 patients during the study period admitted with a diagnosis code for diabetes with peripheral circulatory disorders and a lower extremity wound. The one year readmission rate was 52.2% and the highest readmission rate was found in patients who underwent percutaneous angioplasty during the index admission (58.9%, p<0.01). Multivariable logistic regression revealed that PTA was associated with an increased risk of readmission (OR 1.27, p<0.01) and amputation during the index admission was protective against readmission (OR 0.73, p<0.01). From the readmitted patients, 51.0% had more than one readmission. The strongest risk factors for more than one readmission was renal failure (OR 1.17, p<0.01) and PTA (OR 1.12, p<0.01).

Conclusions:

Patients suffering from diabetes with peripheral circulatory disorders have among the highest readmission rates in the United States. Limb salvage with PTA and open vascular procedures are associated with the highest risk for readmission and multiple readmissions. Patient outcome and cost improvement measures should focus on these at-risk patients.