Re-interventions, readmissions and discharge destination: modern metrics for the assessment of the quality of care

Abstract

Aim: To determine whether administrative data can be used to determine metrics to inform the quality agenda. To determine the relationship between these metrics and the method of abdominal aortic aneurysm (AAA) repair undertaken.

Methods: The Hospital Episode Statistics (HES) data were taken for a 5-year period (01.04.2003-31.03.2008). Cases of elective AAA repair were identified. Outcomes were determined in terms of mortality, discharge destination, re-intervention rates and emergency readmission rates. The results were interpreted in light of whether AAA repair was open or endovascular and whether patients were octogenarians or younger patients.

Results: There were 18,060 elective AAA repairs with a mean in-hospital mortality rate of 5.9%. Of these 14,141 were open repairs with a mean mortality of 6.5% and 3919 EVAR (22%) with a mean mortality of 3.8%. EVAR patients were less likely to be discharged to ongoing care (p < 0.001) but were associated with a higher rate of re-intervention (p = 0.001) than open repairs. No differences were seen in one-year readmission rates. Octogenarians were more likely to undergo EVAR (p = 0.001), to be readmitted within 30-days (p = 0.009), to require further interventions on their index admission (p < 0.001) and less likely to be discharged home (p < 0.001) than younger patients.

Conclusion: Administrative data can be used to identify metrics other than mortality and length of stay. These metrics might be used to inform service provision. In particular for AAA repair, differences in these outcomes were identified between open repair and EVAR and between octogenarians and younger patients.