Trajectory modelling to assess trends in long-term readmission rate among abdominal aortic aneurysm patients
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Published version
Author(s)
Rao, AM
Bottle, Alex
Bicknell, Colin
Darzi, ara
Aylin, paul
Type
Journal Article
Abstract
Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair () patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex () undergoing other vascular procedures (), poor socioeconomic status index (), older age (), and higher comorbidity score (). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair () had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (), heart failure (P = 0.01), peripheral vascular disease (), female sex (P = 0.02), open repair (), and undergoing other related procedures (). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.
Date Issued
2018-10-21
Date Acceptance
2018-09-05
Citation
Surgery Research and Practice, 2018, 2018
ISSN
2356-7759
Publisher
Hindawi Publishing Corporation
Journal / Book Title
Surgery Research and Practice
Volume
2018
Copyright Statement
© 2018 Ahsan Rao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
National Institute for Health Research
Dr Foster Intelligence
Grant Number
RDPSC 79560
RDPSC 79560
n/a
WPPA_P72388
Publication Status
Published
Article Number
4321986