Medicare now levies financial penalties against hospitals for excessive readmissions. Although intensive postdischarge follow-up has been shown to decrease readmissions in medical patients, evidence-based interventions to decrease readmissions in vascular surgery are scant. We sought to examine the effect of a callback program on readmission rates in patients undergoing major vascular surgery. We instituted a predischarge checklist screen and postdischarge callback program in our center for patients undergoing major lower extremity or abdominal vascular surgery. A total of 388 patients were identified in the year prior to (266) and the year after (122) the intervention was initiated. Thirty-day readmission rates, emergency department (ED) visit rates, and early clinic visit rates (defined as a clinic visit less than 14 days postdischarge) were calculated and compared between the pre- and postintervention periods. Major demographic and comorbidities were then used to create a risk-adjusted logistic regression model examining the effect of the interventions on the outcomes. Preintervention 30-day readmission rates were 9.8%, compared to 9.0% after the intervention (P = .81). The most common reason for readmission were infectious/wound-related (40.5%), and the incidence did not differ between pre- and postintervention time periods; additionally, patients with a positive screen for wound concerns at discharge were more likely to be readmitted (P = .04). Postoperative ED visit rates were identical in the postintervention group as compared to the preintervention group, as were the reasons for presentation. Risk-adjusted logistic regression models bore these trends out, though none reached statistical significance. A callback program did not reduce readmissions or direct patients to clinic rather than the ED in a population of patients undergoing major vascular surgery. A focused process for postoperative wound management may yield the highest decrease in readmissions.
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