1004 Does Hospital Teaching Status Influence Risk Factors and Incidence Rate for 30-day Readmission for Hepatic Encephalopathy?

Abstract

INTRODUCTION: Literature suggests that an index admission with Hepatic Encephalopathy (HE) is associated with all-cause readmission and increased mortality in patients with cirrhosis. Teaching hospitals may have higher readmission rates compared to non-teaching hospitals. We determined the 30-day all-cause readmission rate and risk factors for adults admitted with a principal diagnosis of HE in metropolitan teaching and non-teaching hospitals. METHODS: We utilized the Nationwide Readmission Database to identify admissions with a principal diagnosis of HE (ICD-9 572.2). Applicable admissions were all adults (age ≥ 18) from 01/01/2014 to 11/30/2014. Patients who died during index admission, those with missing covariates, or admission to non-metropolitan hospitals were excluded. All-causes including HE readmissions within 30-days of an index HE admission were analyzed. Statistical analysis was completed with Stata 15 (StataCorp, College Station, TX). Predictors for readmission were determined using a multivariate logistic regression model following sequential step-wise elimination of covariates including demographics, comorbidities, hospital characteristics, length of stay (LOS) for index admission, and the modified Elixhauser Comorbidity Index. RESULTS: A total of 19,047 patients met criteria for inclusion. There were 6,362 all-cause readmissions (33.40%) within 30-days of the index HE admission. The readmission rate for patients discharged from a teaching hospital and readmitted to any hospital was 33.65% with non-teaching hospitals at 32.95%. There was not a statistically significant difference (P = 0.32) between the readmission rate for patients discharged from teaching and non-teaching hospitals. There was no statistical difference in readmission for HE (P = 0.78). For non-teaching hospitals, discharge against medical advice, age between 35 and 65, and CKD were predictors for readmission. For teaching hospitals, females, age between 35 and 65, Medicaid insurance, LOS between 7 and 14 days, and CKD predicted readmission. CONCLUSION: Nearly 1 in 3 individuals admitted to a metropolitan hospital (non-teaching or teaching) with a principal diagnosis of HE was readmitted. While there was not a difference in the readmission rate, the risk factors for readmission at teaching and non-teaching hospitals were slightly different. Development of targeted interventions for sub-populations at high risk for readmission, may help to decrease healthcare cost, morbidity and mortality.