Common Sequences of Emergency Readmissions among High-Impact Users following AAA Repair

الملخص EN

Introduction.

The aim of the study was to examine common sequences of causes of readmissions among those patients with multiple hospital admissions, high-impact users, after abdominal aortic aneurysm (AAA) repair and to focus on strategies to reduce long-term readmission rate.

Methods.

The patient cohort (2006–2009) included patients from Hospital Episodes Statistics, the national administrative data of all NHS English hospitals, and followed up for 5 years.

Group-based trajectory modelling and sequence analysis were performed on the data.

Results.

From a total of 16,973 elective AAA repair patients, 18% (n=3055) were high-impact users.

The high-impact users among ruptured abdominal aortic aneurysm (rAAA) repair constituted 17.3% of the patient population (n=4144).

There were 2 subtypes of high-impact users, short-term (7.2%) with initial high readmission rate following by rapid decline and chronic high-impact (10.1%) with persistently high readmission rate.

Common causes of readmissions following elective AAA repair were respiratory tract infection (7.3%), aortic graft complications (6.0%), unspecified chest pain (5.8%), and gastrointestinal haemorrhage (4.8%).

However, high-impact users included significantly increased number of patients with multiple readmissions and distinct sequences of readmissions mainly consisting of COPD (4.7%), respiratory tract infection (4.7%), and ischaemic heart disease (3.3%).

Conclusion.

A significant number of patients were high-impact users after AAA repair.

They had a common and distinct sequence of causes of readmissions following AAA repair, mainly consisting of cardiopulmonary conditions and aortic graft complications.

The common causes of long-term mortality were not related to AAA repair.

The quality of care can be improved by identifying these patients early and focusing on prevention of cardiopulmonary diseases in the community.