Risk Factors for 30-day Readmission in Diverticular Bleeding

Abstract

Introduction: Thirty-day readmissions have become a focus for cost reduction for select clinical conditions. Few studies have identified risk factors among individuals with diverticular hemorrhage for recurrence or readmission. Our aim was to utilize the novel National Readmission Database (NRD) to determine the risk factors for 30-day readmission in patients with diverticular bleeding. Methods: We utilized the Healthcare Cost and Utilization Project's (HCUP) 2013 NRD. Index admissions included had either primary or secondary ICD-9 diagnoses of diverticular bleeding (562.12) and/or diverticulitis with bleeding (562.13). Patients with multiple readmissions and those with an index admission in the month of December were excluded. The primary outcome of interest was risk factors for 30-day readmission. Data was analyzed using Student's t-test and multivariate logistic regression analysis. Results: We identified 34,149 diverticular bleeding admissions, and 28,063 index admissions were included in this analysis. The average patient age was 75.4 years with an average of 6.4 chronic conditions per patient. The average length of stay (LOS) of the index hospitalization was 4.3 days and average cost was $36,551.19. Within 30 days, 823 (2.9%) readmissions were identified. Hospitalizations with 30-day readmission had higher index LOS (P< 0.0001) and total charges (P< 0.0001). Table 1 compares the risk factors between study groups. Hospitalizations more likely to result in readmission included blood transfusion (OR 1.59, 95% CI 1.37 - 1.85) and performance of endoscopy (OR 1.26, 95% CI 1.10 - 1.45). The primary protective factor included performance of abdominal surgery (OR 0.27, 95% CI 0.09 - 0.88). Electrolyte disturbance (OR 0.95, 95% CI 0.79 - 1.14), acute respiratory failure (OR 0.74, 95% CI 0.22 - 2.50) and peripheral vascular disease (OR 0.76, 95% CI 0.56 - 1.01) trended to decreased odds of readmission.Table 1: Risk factors for 30-day readmissionTable 1: ContinuedTable 1: ContinuedConclusion: Patients with hospitalizations for diverticular bleeding tend to be older and have multiple chronic conditions. Blood transfusion or performance of endoscopy increased odds of 30-day readmission. Hospitalizations including abdominal surgery were protective of readmission. Further longitudinal study is required to create validated predictive models.