30-day unplanned readmission rate in otolaryngology patients: A population-based study in Thuringia, Germany.

Wido Rippe,Andreas Mueller,Kerstin Hoffmann,Holger Kaftan,Jens Buentzel,Andreas Dittberner,Gerald Radtke,Orlando Guntinas-Lichius,Daniel Boeger,Peter Dziegielewski

doi:10.1371/journal.pone.0224146

Abstract

Analyze associations between patients' characteristics and treatment factors with 30-day unplanned readmissions in hospitalized otolaryngology patients in the German Diagnosis Related Group (D-DRG) system. A retrospective cohort study was performed on 15.271 otolaryngology admissions of 12.859 patients in 2015 in Thuringia, Germany. The medical records of the 1173 cases (7.6%) with readmission within 30-days were analyzed in detail. The 30-day readmission was planned in 747 cases (4.9%) and was unplanned in 422 cases (2.8%). The median interval between primary and next inpatient treatment was 11 days. The principal diagnosis was the same as during the primary index treatment in 72% of the cases. The most frequent reasons for readmission were: Need for non-surgical therapy (31.2%), need for further surgery (26.3%), post-surgical complaints (16.9%), and recurrence of primary complaints (10.7%). The multivariate analysis revealed that discharge due to patient's request against medical advice was a strong independent factor with high risk for unplanned readmission (Odds Ratio [OR] = 9.62]; confidence interval [CI] = 2.69-34.48). Surgery at index admission (OR = 3.33; CI = 1.86-5.96) was the second important independent risk factor for unplanned readmission. Unplanned readmission had more frequently a non-surgical treatment at readmission than a surgical treatment (OR = 3.92; CI = 2.24-6.84) and needed more frequently further diagnostics (OR = 2.34; CI = 1.34-4.11). The following index International Classification of Diseases (ICD) categories had the highest risk for unplanned readmission: Injury, poisoning and certain other consequences of external causes, ICD: S00-T98 (OR = 66.67; CI = 15.87-333.33), symptoms, signs, abnormal findings, ill-defined causes, not otherwise classified, ICD: R00-R99 (OR = 62.5; CI = 11.76-333.33), blood forming organ diseases, ICD: D50-D90 (OR = 21.276; CI = 3.508-125), and eye/ ear diseases, ICD: H00-H95 (OR = 12.66; CI = 4.29-37.03). The causes of unplanned 30-day readmission in German otolaryngology inpatients are multifactorial. Specific patient and treatment characteristics were identified to be targeted with health care interventions to decrease unplanned readmissions.

Highlights

Unplanned hospital readmissions are an outcome measure in health services research as metric for health care quality and are costly [1]
The 30-day readmission was planned in 747 cases (4.9%) and was unplanned in 422 cases (2.8%)
The following index International Classification of Diseases (ICD) categories had the highest risk for unplanned readmission: Injury, poisoning and certain other consequences of external

Summary

Introduction

Unplanned hospital readmissions are an outcome measure in health services research as metric for health care quality and are costly [1]. Avoidable readmissions can be the consequence of an adverse event or a too early discharge of a prior hospitalization [2]. The risks of early discharge in order to cut costs have been well documented ever since DRG systems were first introduced [4]. In the German DRG (G-DRG) system, readmissions for the same cause within 30 days after discharge are reimbursed by the original DRG and receive no additional funds. This approach financially penalizes inappropriate early discharge (at least if it leads to readmission) [4]

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