ANALYSIS OF READMISSION OUTCOMES AND MORBIDITY IN SURVIVORS OF ARDS

Abstract

SESSION TITLE: Monday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Acute respiratory distress syndrome (ARDS) carries a significant mortality risk among patients affected. In those who survive, it also leads to increased risk for sustaining disabilities with impairments in cognition and physical function that impact the quality of life. The goal of this study is to assess the long-term morbidity among ARDS survivors based on hospital readmission rates, risk factors that increase it, as well as outcomes of subsequent hospitalizations. METHODS: This is a retrospective analysis based on the 2014 National Readmission Database (NRD). Adults over age 18 with a primary or secondary diagnosis of ARDS based on ICD-9 codes in their index admission were included in this study. Hospital readmission was defined as a successive admission with any non-trauma diagnosis within 30 days following discharge. Same day readmissions, as well as transfers, were excluded. The primary outcome was the rate of 30-day readmission. Secondary outcomes include readmission risk factors, mortality, discharge destination, resource utilization as defined by lengths of stay (LOS) and cost, and finally the most frequent primary readmission diagnoses. Multivariate regressions with Cox proportional hazard models were used to assess for independent readmission risk factors. RESULTS: A total of 521,415 patients with ARDS were identified in this cohort and 341,824 (34%) survived their index admission. Among the survivors, 35.7% had prolonged mechanical ventilation greater than 96 hours, 0.14% received ECMO, and 17.8% had concurrent septic shock. 34.8% of the survivors were discharged to home with routine care, 42.9% were discharged to either a skilled nursing (SNF) or intermediate care facility (ICF), and 15.8% were discharged home with nursing services. A total of 8,708 (2.5%) patients were readmitted within 30-days. The top 5 most common primary readmission diagnoses were unspecified septicemia (n=2,338), acute respiratory failure (n=1,997), pneumonia due to unspecified organism (n=174), aspiration pneumonia (n=170), and MRSA septicemia (n=111). Mortality in the readmitted population was 29.9%, and 51.3% were discharged to a SNF or ICF. The mean readmission LOS was 13.8 days and the mean cost was $41,593. Independent risk factors for readmission include lower income (HR 1.17), increasing age (HR 1.01), higher Charlson comorbidity index (HR 1.27), index SNF/ICF discharge (HR 1.49), and septic shock (HR 1.25). All p-values were <0.001. CONCLUSIONS: ARDS leads to significant complications in patients who survive, especially among those who are readmitted within 30 days. Sepsis-related diagnoses are the primary drivers of readmission. Further analysis will be conducted with longer follow-up periods at 60 to 90 days to assess ARDS' continued impact on survivors. CLINICAL IMPLICATIONS: Few prospective trials are available that address ARDS survivor outcomes, which can be areas of investigation in future studies. DISCLOSURES: No relevant relationships by Laura Chen, source=Web Response No relevant relationships by Di Pan, source=Web Response No relevant relationships by Bertin Salguero, source=Web Response No relevant relationships by Fernando Vazquez de Lara, source=Web Response