INCIDENCE AND PREDICTORS OF 30-DAY READMISSION IN PATIENTS HOSPITALIZED WITH ASPIRATION PNEUMONIA

Abstract

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Aspiration pneumonia is a subtype of pneumonia caused by large-volume aspiration of oropharyngeal colonization or gastric content. Our study aimed to estimate the rate, risk factors, and costs associated with 30- day readmissions after aspiration pneumonia hospitalizations in a large, nationally representative cohort. METHODS: We analyzed the 2016 and 2017 U.S. National Readmission Database (NRD) to identify adult patients admitted with a principal diagnosis of aspiration pneumonia. A readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. We examined the baseline demographics, national readmission rates, resource utilization. We used the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM) to identify the diagnosis. Multivariate logistic regression was used to identify predictors of 30- day readmission. RESULTS: A total of 252,904 patients admitted with aspiration pneumonia were identified. The mean age was 73.8. 43.7% of patients were female. 35% of patients had dysphagia, 26.9% had dementia, 17% had altered mental status, 13.3% had palliative care encounter. The all-cause 30-day readmission rate was 17%. The in-hospital and 30-day mortality rate was 7.9% and 9.2%, respectively. The in-hospital mortality rate for readmitted patients was 9.4%. The most common five reasons for all-cause readmission were aspiration pneumonia, sepsis, unspecified pneumonia, acute kidney injury, chronic obstructive pulmonary disease with (acute) exacerbation. After adjusting for multiple covariates, readmission within 30 days was independently associated with higher Charlson comorbidity score [adjusted odds ratio (aOR) 1.1, 95% confidence interval (CI) 1.10- 1.12, p<0.001], dysphagia (aOR 1.1, 95% CI 1.06- 1.14, p<0.001). Female sex (aOR 0.93, 95% CI 0.89- 0.96, p<0.001), palliative encounter (aOR 0.37, 95% CI 0.34- 0.40, p<0.001), higher income (aOR 0.92, 95% CI 0.87- 0.97, p<0.001), using private insurance (aOR 0.74, 95% CI 0.69- 0.79, p<0.001), alcohol use (aOR 0.90, 95% CI 0.83- 0.98, p=0.016), dementia (aOR 0.82, 95% CI 0.78- 0.85, p<0.001) were associated with decreased all-cause readmissions. The mean length of stay (LOS) of index admissions and readmissions was 6.62 vs 6.71 days (p=0.122), and the mean cost was $13,987 vs. $14,598 (p<0.001). CONCLUSIONS: Patients admitted for aspiration pneumonia were frequently readmitted to the hospital within 30 days after discharge. We found a significant burden of 30-day readmissions, including higher in-hospital mortality rate and resource utilization. CLINICAL IMPLICATIONS: Our findings might be used to develop strategies to reduce early readmission of aspiration pneumonia. Additional attention should be directed toward these patients in the form of careful discharge planning and a multidisciplinary approach to swallowing management. DISCLOSURES: No relevant relationships by Si Li, source=Web Response No relevant relationships by Bojana Milekic, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Yichen Wang, source=Web Response