S0833 Is 30-Day Readmission of Ulcerative Colitis More Expensive and Severe?: A Nationwide Analysis

Abstract

INTRODUCTION: Decreasing healthcare related costs has become a priority for the health care system in United States.Approximately one in five patients with Medicare are readmitted within 30 days, accounting to annual costs of $ 17.4 billion. Our aim is to identify mortality, Length of stay and cost of 30-day readmission in comparison to index admission in patients with Ulcerative colitis. METHODS: In this retrospective cohort study, we utilized Nationwide Readmission Database (NRD) for the year 2016 and 2017. In United States, NRD is the largest publicly available all-payer inpatient health care readmission database. We used the ICD10-CM diagnosis code K51.x to identify all adult patients with UC. RESULTS: There were 71,500,000 hospitalizations in 2016–2017 in the United States, 54,138 index admissions had UC as the primary diagnosis whereas 93,192 admission had UC as secondary diagnosis. 6, 556 patients (13.2%) were non-electively readmitted within 30-days of an index admission for primary. The in-hospital mortality rate during readmissions was significantly higher than that of the index admission (1.4% vs 0.3%, P < 0.01). Patients who got readmitted had higher proportion of malnourishment(24.4% vs 12.0%, P < 0.01), electrolyte disturbance(39% vs 31.3, P < 0.01), Acute Kidney injury(9.5% vs 8.0%, P < 0.01), bowel obstruction (4.5% vs 3.7%, P < 0.01), Vitamin D deficiency(3.8% vs 2.6%, P < 0.01), anemia(9.1% vs 4.5%, P < 0.01), Clostridium difficile infection (10.6% vs 3.5%, P < 0.01) and toxic megacolon(0.3% vs 0.1%, P < 0.01) as compared to index admission. Readmitted patients had higher ICU admission (1.7% vs 0.5%, P < 0.0001), shock (4.4% vs 2.8%, P < 0.0001), and higher blood transfusion rate (12.6% vs 7.5%, P < 0.0001) in comparison to patients who were not readmitted (Tables 1 and 2). The mean length of hospital stay was 7.0 days (IQR: 6.8-7.1) days, which was longer than those of index admissions (4.9 days (IQR: 4.8–4.9), P < 0.01). The mean total hospitalization charges were $62,552($58,821–$66,282) without imputation, which were higher than those of index admissions (mean total hospitalization charges: $46,971(45,130–48,811), P < 0.01). CONCLUSION: Our study showednot only are the 30-day readmission rates are more expensive, but with higher comorbidities and severity compared to index admissions.Table 1.: Patient related factors comparing patient’s readmission versus no readmission in Ulcerative colitis Hospitalization with unplanned 30-day readmissionTable 1.: Patient related factors comparing patient’s readmission versus no readmission in Ulcerative colitis Hospitalization with unplanned 30-day readmissionTable 2.: Hospital related factors comparing patient’s readmission versus no readmission in Ulcerative colitis Hospitalization with unplanned 30-day readmission