S0167 Liver Cirrhosis and ESRD Are Independent Predictors of 30-Day Readmission in Patients With Clostridioides difficile Colitis: A Nationwide Analysis

Abstract

INTRODUCTION: Clostridioides difficile infection (CDI) is the most common healthcare associated infection in the US. CDI associated hospitalization has a significant clinical and financial burden on the US healthcare system, which is only worsened by early readmissions. We performed an analysis using the Nationwide Readmission Database (NRD) to look at 30-day all-cause readmission and independent predictors of readmission in CDI. METHODS: We queried the 2017 Nationwide Readmission Database (NRD) using ICD-10-CM diagnosis codes to identify all adult patients admitted with a primary diagnosis of CDI from January to November 2017. Outcomes assessed were 30-day readmission rates, mortality, length of stay (LOS) and hospitalization costs. A multivariate cox regression was done to identify independent predictors of readmission. Statistical analysis was performed using STATA software. RESULTS: A total of 83,865 adult patients were admitted with a primary diagnosis of CDI in 2017, with in-hospital mortality rate of 1.41% (1,183). Of these, 22.37% (18,764) patients were readmitted within 30-days. The most common primary diagnosis at readmission was “Enterocolitis due to Clostridium difficile” (20.47%). When compared to index admission, readmitted patients had higher in-hospital mortality (1.41% vs 4.86%, P < 0.01), increased mean LOS (5.59 days vs 6.56 days, P < 0.01) and higher mean hospitalization charges ($41,146 vs $58,854, P < 0.01). 30-day readmission added 123,225 inpatient days and $272 million in hospitalization cost to the healthcare burden. Higher charlson comorbidity score (HR 1.08, P < 0.01), Medicaid (HR1.16, P < 0.01), longer LOS (HR 1.01, P < 0.01), liver cirrhosis (HR 1.31, P < 0.01), Type 1 DM (HR 1.38, P < 00.01) and ESRD (HR 1.36, P < 0.01) were associated with increased 30-day readmission, whereas female gender (HR 0.93, P < 0.01), age greater than 60 years [60–80 years (HR 0.79, P < 0.01), >80 years (HR 0.81, P < 0.01] and private insurance (HR 0.84, P < 0.01) were associated with decreased 30-day readmission. CONCLUSION: In the US, almost 1 in 5 patients with CDI is readmitted within 30 days of discharge. Readmission is associated with significantly increased in-hospital mortality, LOS, and increased hospitalization costs. Type 1 DM, ESRD, liver cirrhosis, higher comorbidity burden, Medicaid insurance and longer LOS were independent predictors of 30-day readmission. Further studies are needed to assess the high-risk populations to understand the reasons predisposing to early readmission.Table 1.: Independent predictors of 30-day readmission in patients with CDI