P123 THIRTY DAY READMISSIONS AMONG PATIENTS WITH COMPLICATED INFLAMMATORY BOWEL DISEASE AND EFFECTS ON OUTCOMES: RESULTS OF ANALYSIS OF 2016 NATIONWIDE READMISSION DATABASE

Abstract

Abstract Objective To determine the rate of hospital readmissions within 30 days of discharge in patients with complicated Inflammatory Bowel Disease (IBD) and its impact on mortality, morbidity, and health care cost in the United States. Methods We performed a retrospective study using the Nationwide Readmission Database(NRD) for the year 2016 (Data on 35.6 million discharges). We collected data on hospital readmissions of 29,356 adults who were hospitalized for complicated Inflammatory Bowel Disease(Crohn’s disease and Ulcerative Colitis) and discharged. Complications were defined using ICD 10 codes. Patients with age less than 18, elective admission and admission during December month were excluded. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity and resource use. Multivariate regression analysis was used to determine the independent predictors of 30-day readmission. Results Among patients admitted to US hospitals with complicated IBD, the total time at risk was 407,983 days, with the first readmission occurring at day 1 and the last readmission at day 30. The 30-day rate of readmission was 17.6%, with the most common cause of readmission being Crohn’s disease of small intestine with intestinal obstruction (9%). The mortality rate among patients readmitted to the hospital (0.6%), was higher than that for index admissions (0.3%) (P < .01). Mean length of stay was 5.5 days for index admission and 5.9 days for readmission (p=0.01). Mean total charge for index admission was $44,768 compared to $48,766 for readmission (p<0.01). Mean total cost for index admission was $11,491 compared to $12,704 for readmission (p<0.01). A total of 30,943 hospital days were associated with readmission, and the total health care in-hospital economic burden was $65 million (in costs) and $251 million (in charges). Independent predictors of readmission were age, insurance status, higher Charlson comorbidity score, lower income, teaching status of hospital and longer stays in the hospital. Older age, private insurance, median income more than $48,000 were associated with lower odds for readmission, whereas higher comorbidities and admission to teaching hospital were associated with increased odds for readmission. Conclusions In a retrospective study of patients hospitalized for complicated IBD in 2016, 17.6% were readmitted to the hospital within 30 days of discharge. Readmission was associated with higher mortality, morbidity, and resource use. Age, insurance status, higher comorbidity score, lower income and admission to teaching hospital were independent predictors of readmission.