Comparative analysis of 30-day and 90-day readmissions after carotid endarterectomy versus carotid artery stenting: a nationwide retrospective cohort study using the U.S. nationwide readmissions database

BACKGROUND/OBJECTIVES: Readmission after carotid revascularization is an important quality indicator; however, comparative evidence for carotid endarterectomy (CEA) versus carotid artery stenting (CAS) remains focused mainly on 30-day outcomes. We compared unplanned 30-day and 90-day readmissions after nonelective CEA versus CAS and identified predictors, principal readmission diagnoses, and readmission-related resource utilization. METHODS: We conducted a retrospective cohort study using the 2016-2017 Nationwide Readmission Database. Adults aged ≥ 18 years who underwent nonelective carotid revascularization were included. The 30-day cohort comprised 56,207 index admissions (CEA, 39,912; CAS, 16,295), and the 90-day cohort comprised 46,481 index admissions (CEA, 33,064; CAS, 13,418). Survey-weighted multivariable logistic regression was used to estimate the readmission risk, and generalized linear models were used to assess the index admission length of stay and total hospital charges. RESULTS: After adjustment, CAS and CEA had similar odds of 30-day readmission (OR 1.11, 95% CI 0.99-1.24; p = 0.065), whereas CAS was associated with higher odds of 90-day readmission (OR 1.12, 95% CI 1.03-1.22; p = 0.010). Index admissions for CAS involved longer hospital stays than CEA (11 vs. 9 days; p = 0.006 and p = 0.004) and higher total charges (USD 207,627 vs. 139,063 at 30 days; USD 204,055 vs. 138,216 at 90 days; both p < 0.001; difference ~ USD 66,000-69,000 per episode). Independent predictors of readmission included congestive heart failure, diabetes mellitus, chronic kidney disease, coronary artery disease, atrial fibrillation, and metastatic cancer; depression independently predicted 90-day readmission only (OR 1.19; p = 0.005). Cerebrovascular diagnoses accounted for most of the readmissions. CONCLUSIONS: CEA and CAS had similar adjusted 30-day readmission risks; however, CAS was associated with a higher 90-day readmission risk and higher index admission resource use. Specific comorbidities, particularly CHF, diabetes, CKD, atrial fibrillation, metastatic cancer, and depression (at 90 days), identify patients who may benefit most from targeted peri-discharge optimization. These findings support extended post-discharge surveillance after CAS, comorbidity-focused transition planning, and SNF-to-home pathway reviews.