IP: Interactive Poster SessionIP135. Thirty- and Ninety-Day Hospital Readmission After Outpatient Upper Extremity Hemodialysis Access Creation

Patients with end-stage renal disease have multiple comorbidities and are at high risk for postoperative complications and resource utilization. Our goal was to determine the rate and causes of 30- and 90-day hospital readmission rates after creation of outpatient hemodialysis access. We performed a retrospective review of all upper extremity hemodialysis access creations from 2008 to 2015 that were classified as outpatients. Procedure details, patient comorbidities, emergency department (ED) visits, and hospital readmissions at 30 and 90 days were recorded. Reasons for the admission and multivariate analysis of risk factors were analyzed. Readmission was defined as any inpatient status admission within 30 and 90 days. There were 537 patients identified. Access fistulas included brachiocephalic (50.7%), brachiobasilic (22.5%), prosthetic graft (20%), and radiocephalic (4.5%). The average age was 59 years, and 60% were male. The 90-day mortality rate was 0.7%. Readmission rates were 26% at 30 days and 48% at 90 days. Reasons for admission were related to the access in 14.2% and the dialysis catheter in 7.9% of cases. Other reasons for admission included shortness of breath/volume overload (23.6%), gastrointestinal (17.2%), cardiac/chest pain (14.8%), unrelated infectious causes (11.8%), failure to thrive (6.9%), altered mental status (5.9%), electrolyte abnormalities (3.9%), and musculoskeletal (3.4%). Preoperative predictors of all cause 30-day readmission included dementia (OR, 5.76; 95% CI, 1.34-24.8; P = .018), hypertension (OR, 3.92; 95% CI, 1.07-14.4; P = .039), COPD (OR, 2.19; 95% CI, 1.01-4.76; P = .046), and current smoking (OR, 2.14; 95% CI, 1.32-3.47; P = .002). Predictors of all cause 90-day readmission were hepatic insufficiency (OR, 6.08; 95% CI, 1.2-30.8; P = .029), hypertension (OR, 3.43; 95% CI, 1.36-8.65; P = .009), black race (OR, 2.47; 95% CI, 1.48-4.14; P = .001), Hispanic race (OR, 2.04; 95% CI, 1.01-4.11; P = .046), and obesity (OR, 1.5; 95% CI, 1.02-2.19; P = .039). Predictors of 90-day access-related readmission included COPD (OR, 5.27; 95% CI, 1.38-20.0; P = .015), previous stroke (OR, 3.76; 95% CI, 1.5-9.4; P = .005), dialysis at time of operation (OR, 2.8; 95% CI, 1.17-6.84; P = .022), and prosthetic graft placement (OR, 2.86; 95% CI, 1.07-7.6; P = .036). An additional 9.7% had at least one ED presentation within 90 days but were not admitted. Patients undergoing placement of hemodialysis access are at high risk for readmission, mostly unrelated to their operation. Enhanced outpatient medical optimization of these patients may lead to a decrease in readmissions postoperatively. This has an impact for both global care for these patients as well as care of these patients in accountable care organizations.