S0738 Predictors of Readmission From Clostridium difficile Infection in Hospitalized IBD Patients

Abstract

INTRODUCTION: Incidence of C. Difficile infection (CDI) has doubled in IBD patients over the last decade. There has been an increasing trend of readmission stemming from CDI. Identification of factors associated with readmission with CDI in this patient population would be beneficial to mitigate readmission and subsequently reduce healthcare burden. Thus, we aimed to evaluate 30 day readmission rates related to CDI and associated factors in IBD patients. METHODS: Hospitalized patients with IBD were identified using ICD-9-CM codes from the Nationwide Readmissions Database from 2010 through 2014. IBD related complications and procedures during hospitalization were also identified using ICD-9-CM codes. We excluded readmission analysis of patients with the following: age <18, died during initial hospitalization, elective readmission, discharged in December of each year. All cause 30-day readmission rate and 30-day readmissions with CDI were calculated. Yearly trend was assessed with Cochrane Armitage Trend test. We used multivariable regression to assess risk factors associated with CDI related readmission and presented the data as an adjusted odds ratio (aOR). RESULTS: Total of 1,350,428 hospitalized patients with IBD were followed for 30 days from year 2010 to 2014. Out of 234,261 readmitted patients, 15,386 (6.6%) of patients had readmission with CDI. Baseline characteristics of index hospitalization are shown in Table 1. Percentage of readmitted patients with CDI has remained stable around 6.9% as seen in Figure 1. Younger age group (18–39) had 15% lower readmission with CDI compared to older population (≥65 years). Interestingly, patients with colon cancer had 50% lower odds of readmission with CDI. Patients undergoing colectomy had 70% lower odds of readmission with CDI. After adjusting for confounding, patients with Ulcerative Colitis (UC) had a two-fold higher odds of readmission with CDI compared to Crohn’s disease (CD) patients. Hospital length of stay more than 3 days doubled the odds of being readmitted with CDI. Other factors associated with increased odds of readmission with CDI are shown in Table 2. CONCLUSION: Younger patients have lower readmission from CDI. Patient's with UC and longer length of stay (>3 days) are at higher risk of readmission with CDI. Decreasing unnecessary hospitalizations and special attention to the UC population may decrease CDI related readmissions in IBD patients.Table 1.: Baseline characteristics of patient population during index hospitalizationFigure 1.: Readmission rate trend for CDI in patients with IBD.Table 2.: Factors associated with readmission for CDI in patients with IBD