388 Rate of psoriasis readmission has decreased in the united states: A 9- year longitudinal nationwide study

Abstract

This study aims to study longitudinal trends of 30-day readmissions of psoriasis patients over time in the United States (US) using national population data. Data were obtained from the National readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis of NRD 2010 (year of inception)-2018 databases. We searched for index hospitalizations for patients aged≥ 18 years with a principal or secondary diagnosis of psoriasis using ICD codes for the corresponding year. We excluded elective and traumatic readmissions. The trend in the 30-day readmission rate was our primary outcome. Multivariate logistic and linear regression was used to calculate adjusted p-trend for categorical and continuous outcomes, respectively. The rate of decrease in 30-day readmission rate was steeper for patients admitted with a principal diagnosis of psoriasis (16.7% in 2010 to 10.2% in 2018, adjusted p-trend=0.002) compared to patients admitted with any diagnosis of psoriasis (12.2% in 2010 to 10.4% in 2018, adjusted p-trend<0.0001). Inpatient mortality of readmissions decreased from 4.4% in 2010 to 4.2% in 2018, with a nadir of 3.8% in 2016 (adjusted p-trend<0.0001). The mean length of stay (LOS) decreased from 6.3 days in 2010 to 5.8 days in 2018 (adjusted p-trend<0.0001). Proportion of readmitted patients with Charleston index score ≥3 increased from 0% in 2010 to 51.6% in 2018 (adjusted p-trend<0.0001). Adjusted total hospital cost increased from 13,636 to 14,112 US dollars (adjusted p-trend=0.010). Sepsis was the most common reason for readmission across all years. The rate of readmission has decreased for patients admitted principally because of psoriasis and all admissions of psoriasis patients; however, this decrease is more precipitous for the former. Although hospital cost and comorbidity burden of psoriasis readmissions has increased over time, inpatient mortality and LOS have decreased. These may be due to better outpatient management and more effective treatment options available in recent times.