S866 Malnutrition and Opioid Use Disorder Are Associated With Higher 30-Day Readmission Rates in Patients Initially Admitted for Ulcerative Colitis

Abstract

Introduction: Ulcerative colitis (UC) is a chronic disorder that predisposes patients to multiple complications. Readmissions to the hospital pose a burden to patients and health-care systems. Preventing readmissions is important for quality of care and quality of life of patients with UC. We aim to identify the incidence of 30-day readmissions and its predictors. Methods: Retrospective review of the 2018 National Readmission Database (NRD) of adult patients readmitted after an index admission of UC. ICD-10CM/PCS codes were used to identify UC, other comorbidities and procedures. We identified the most common causes for readmission and independent risk factors for readmission were identified using Cox regression analysis. Results: A total of 68,889 index admission (IA) patients were identified, out of which 16.5% (n=11,411) were readmitted within 30-days of discharge. 8.3% of readmissions were secondary to sepsis. Readmitted patients had higher rates of in-hospital mortality (3.4% vs. 2.1%; P< 0.01). Readmitted patients were less likely to be female (50.5% vs 52.8%; P< 0.01), to have private insurance (34.4% vs 40.3%; P< 0.01), to undergo colonoscopy (10.8% vs 17.7%; P< 0.01) and to be from the highest quartile of income (21.9% vs 23.3%; P=0.01). They were more likely to be older (54.0 vs 53.2 years; P< 0.01), to have a Charlson Comorbidity Index (CCI) score of ≥3 (34.1 vs 24.1; P< 0.01), to be from large metropolitan areas with at least 1 million residents (61.1 vs 59.9; P< 0.01), to require parenteral nutrition (3.2% vs 1.5%; P< 0.01), to be malnourished (20.3% vs 11.8%; P< 0.01), to have concomitant Clostridium difficile (6.9% vs. 5.7%; P< 0.01), primary sclerosing cholangitis (0.5% vs 0.2%; P< 0.01) and opioid use disorder (OUD) (3.5% vs 2.4%; P< 0.01). Independent predictors of readmission were CCI of ≥ 3 (aHR 1.95; 95% CI [1.78- 2.13]), undergoing ileostomy during IA (aHR 1.39; 95% CI [1.06-1.82]), increasing LOS (aHR 1.00; 95% CI [1.00-1.01), malnutrition (aHR 1.29; 95% CI [1.17-1.43]) and OUD (aHR 1.45; 95% CI [1.26-1.68]). Private insurance (aHR 0.78; 95% CI [0.72-0.85]), female gender (aHR 0.92; 95% CI [0.87-0.98]) and younger age (aHR 0.99; 95% CI [0.99-0.99]) were associated with less odds of early readmission. (Figure) (Table) Conclusion: The 30-day readmission rate for UC in 2018 was 16.5%. Readmission is associated with higher mortality and are associated with risk factors such as malnutrition and OUD. Early readmissions in UC continues to pose a high burden to patients and our health-care system.Figure 1.: Kaplan Meier graph of 30-day readmission Table 1. - Independent Predictors of 30-day readmission Variable Adjusted odds ratio (95% confidence interval) P value Female 0.92 (0.87-0.98) < 0.01 Age 0.99 (0.99-0.99) < 0.01 Length of stay 1.00 (1.00-1.01) < 0.01 Insurance Provider Medicare Reference Reference Medicaid 0.96 (0.87-1.06) 0.48 Private 0.78 (0.72-0.85) < 0.01 Uninsured 0.81 (0.69-0.96) 0.01 Charlson Comorbidity Index Score 0 1 Reference Reference 2 1.12 (1.03-1.22) < 0.01 ≥3 1.37 (1.24-1.51) < 0.01 Patient residence Large metropolitan area with at least 1 million residents Reference Reference Small metropolitan areas with less than 1 million residents 0.98 (0.92-1.05) 0.75 Micropolitan areas 0.94 (0.79-1.12) 0.53 Not metropolitan or micropolitan (nonurban residual) 0.75 (0.55-1.04) 0.08 In-Hospital Procedures Partial Colectomy 0.91 (0.62-1.32) 0.63 Total colectomy 0.92 (0.70-1.22) 0.58 Ileostomy 1.39 (1.06- 1.82) 0.01 Colonoscopy 1.04 (0.89-1.23) 0.57 Parenteral nutrition 1.19 (0.97-1.46) 0.09 Other Comorbidities Malnutrition 1.29 (1.17-1.43) < 0.01 Obesity 1.00 (0.92-1.08) 0.95 PSC 1.44 (0.98-2.11) 0.06 Alcohol use disorder 1.05 (0.92-1.19) 0.42 Opioid use disorder 1.45 (1.26-1.68) < 0.01 Cannabis use disorder 0.87 (0.72-1.06) 0.18 Diabetes type 1 1.49 (0.98-2.26) 0.06 Diabetes type 2 1.01 (0.93-1.09) 0.74 Shock 1.09 (0.87-1.38) 0.41 Teaching bed size Small Reference Medium 0.96 (0.87-1.06) 0.45 Large 1.06 (0.97-1.15) 0.16