Abstract
Acute Respiratory Distress Syndrome affects approximately 10% of patients admitted to intensive care units internationally, with as many as 40%-52% of patients reporting re-hospitalization within one year. To describe the epidemiology of patients with acute respiratory distress syndrome who require 30-day readmission, and to describe associated costs. A cross-sectional analysis of the 2016 Healthcare Cost and Utilization Project's Nationwide Readmission Database, which is a population-based administrative database which includes discharge data from U.S. hospitals. Inclusion criteria: hospital discharge records for adults age > 17 years old, with a diagnosis of ARDS on index admission, with associated procedure codes for endotracheal intubation and/or invasive mechanical ventilation, who were discharged alive. Primary exposure is adult hospitalization for meeting criteria as described. The primary outcome measure is 30-day readmission rate, as well as patient characteristics and time distribution of readmissions. Nationally, 25,170 admissions meeting criteria were identified. Index admission mortality rate was 37.5% (95% confidence interval [CI], 36.2-38.8). 15,730 records of those surviving hospitalization had complete discharge information. 30-day readmission rate was 18.4%, with 14% of total readmissions occurring within 2 calendar days of discharge; these early readmissions had higher mortality risk (odds ratio 1.82, 95% CI 1.05-6.56) compared with readmission in subsequent days. For the closest all-cause readmission within 30 days, the mean cost was $26,971, with a total national cost of over $75.6 million. Thirty-day readmission occurred in 18.4% of patients with acute respiratory distress syndrome in this sample, and early readmission is strongly associated with increased mortality compared to late readmission. Further research is needed to clarify whether the rehospitalizations or associated mortalities are preventable.
Highlights
The Acute Respiratory Distress Syndrome (ARDS) is characterized by acute lung injury, often a result of pneumonia, sepsis, aspiration, pancreatitis, or trauma
Index admission mortality rate was 37.5% (95% confidence interval [CI], 36.2–38.8). 15,730 records of those surviving hospitalization had complete discharge information. 30-day readmission rate was 18.4%, with 14% of total readmissions occurring within 2 calendar days of discharge; these early readmissions had higher mortality risk compared with
Acute respiratory distress syndrome readmissions: A nationwide cross-sectional analysis data, and available to anyone in the same manner as it was made available to our team
Summary
The Acute Respiratory Distress Syndrome (ARDS) is characterized by acute lung injury, often a result of pneumonia, sepsis, aspiration, pancreatitis, or trauma. It affects approximately ten percent of patients admitted to intensive care units (ICUs) internationally [1], with U.S incidence as high as 190,600 cases per year [2]. The ongoing burden of healthcare utilization for patients with ARDS is high, with 40%-52% of patients requiring re-hospitalization in one year [3, 4] In another cohort roughly half of patients required inpatient or post-acute care for 48 days or more after ICU discharge [5]. Acute Respiratory Distress Syndrome affects approximately 10% of patients admitted to intensive care units internationally, with as many as 40%-52% of patients reporting re-hospitalization within one year.
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