S0740 Economic Impact and Health-Care Utilization Trends Related to Hospitalization and Hospital Readmissions in Patients With Inflammatory Bowel Disease (IBD): A U.S. Population Cohort Study

Abstract

INTRODUCTION: Hospitalization and readmissions (RAs) are considered poor quality outcomes in IBD patients (pts). However, the financial impact of RAs and predictors of this outcome are less well characterized in IBD. We hypothesized that since newer biologics have improved care of pts with IBD over the past years then there should be a beneficial impact on the cost of care, length of stay (LOS) and mortality during the index and RA hospitalization and reduction in 30-day RAs in pts with IBD. METHODS: This is a retrospective cohort study using the National Readmission Database (data on 17 million discharges each year in 27 states, accounting for 56% of all U.S. hospitalization). We identified pts admitted with IBD from 2010 to 2014 using ICD-9-CM codes. We excluded patients with age <18 yrs or who died during their index hospitalization or had elective RA. Trends of the total cost, LOS and in-hospital mortality was assessed in both the index and the RA hospitalization. Trend analysis was performed using the Cochrane Armitage Trend test. The cost was inflation-adjusted in reference to 2020. We also evaluated risk factors associated with 30-day hospital RA using multivariable logistic regression. RESULTS: The total number of index IBD admissions were 1,350,428, of which 234,216 (17.3%) were readmitted to the hospital within 30 days. From 2010 to 2014, 30-day RA trends remained stable at ∼17% (Figure 1A) and the in-hospital mortality trend in readmitted pts remained stable at 0.5%. (Figure 1B). While the mean LOS of the index hospitalization was stable at 5.5 days from 2010 to 2014 (Figure 2A), the aggregate cost of hospitalization decreased from 59 million to 55 million USD. There was a simultaneous rise in RA cost from 9.4 million to 12.5 million USD (Figure 2B). Table 1 shows the independent predictors of 30-days hospital RA. Younger age, male sex, longer index hospital LOS, higher comorbidities, the presence of VTE and C. diff infection during the index hospitalization were associated with an increased risk of 30-days RA. CONCLUSION: Despite the advent of new biologics and their widespread use, we found that the 30-day hospital RA rate, index and RA LOS and in-hospital mortality were unchanged in a nationwide cohort of IBD pts from 2010 to 2014, and interestingly the economic burden related to RA is increasing. We identified risk factors associated with 30-days RA. Pts at risk for RA need to be targeted during their index hospitalization in order to attempt to lessen the economic burden.Figure 1.: A) Trend of 30-day all-cause readmission B) Trend of 30-day inpatient mortality.Figure 2.: A) The trend of the length of stay on index hospitalization and following readmission B) The trend of aggregate cost of hospitalization on index hospitalization and following readmission.Table 1.: Factors associated with 30-day readmission in IBD patients