Comparison of 30-Day Readmission Rates Among Common Gastrointestinal Disorders: A Nationwide Analysis

Abstract

Introduction: Hospital readmissions are a growing problem with significant quality and financial implications. Centers for Medicare and Medicaid often penalize hospitals for excessive readmissions. It is important to identify the causes of these readmissions and formulate plans to prevent them. The aim of this study was to use a national database to compare and contrast readmission rates among nine common gastrointestinal disorders. Methods: We performed a retrospective analysis using the 2013 National Readmission Database (NRD). NRD consists of data from 21 states and is representative of 49.5% of the US population. Index stays were identified from January to November to allow for a 30-day readmission window for all index stays. Index stays require “live” discharge status and non-missing length of stay. Common gastrointestinal disorders such as abdominal pain, acute pancreatitis, chronic pancreatitis, Clostridium difficile infection (C diff), diverticulitis, gastroparesis, inflammatory bowel disease, lower GI bleeding and upper GI bleeding were reviewed. Readmission rate, mean length of stay, average cost per readmission and mean time to readmission were calculated. Data are presented as mean ± standard deviation for continuous variables or weighted frequency (%) for categorical factors. All analyses were performed using SAS (version 9.4, The SAS Institute, Cary, NC). Results: A total of 35,580,348 hospitalizations were analyzed for 2013. All cause readmission rates for gastrointestinal disorders ranged from 7.1 % to 13.8%. Diverticulitis was associated with the least readmission rate (7.1%) whereas gastroparesis was associated with the highest readmission rate (13.8%) with chronic pancreatitis being a close second (13.6%). The mean length of stay per readmission was lowest for abdominal pain at 2.6 days and highest for C diff at 5.7 days. The mean total charges per readmission were highest for chronic pancreatitis and lowest for abdominal pain. The mean time to readmission was also lowest for abdominal pain and highest for patients discharged with a diagnosis of C diff. Conclusion: Hospital readmission rates are fairly common for gastrointestinal disorders in the United States. Gastroparesis and Chronic Pancreatitis have the highest readmission rates whereas diverticulitis has the lowest. Time to readmission was shortest for abdominal pain and longest for C diff. Further studies to identify the risk factors for readmissions and possible interventions to reduce them are warranted.Figure 1Figure 2