Sa1247 Risk Factors for Re-Hospitalization Within 90 Days in Patients With Inflammatory Bowel Disease Are Not Related to Disease Activity

Abstract

Background: Previous studies have demonstrated that the care of inflammatory bowel disease (IBD) patients poses a significant burden to the healthcare system. More than one and a half million people in the United States suffer from ulcerative colitis (UC) and Crohn's disease (CD) and these patients require more frequent hospital admissions than non-IBD patients, and have an increased average length of stay. Moreover, hospital care for IBD patients has been shown to be twice as expensive as that for non-IBD controls. Repeat hospitalization in subgroups of IBD patients appears to be a large part of this issue, however there is only limited literature examining the characteristics of IBD patients that are associated frequent hospital use. Aims: To characterize admission patterns in patients with IBD at a tertiary care referral center, and identify preventable causes of 90-day readmission after an index IBD admission. Methods: Data was gathered retrospectively from a tertiary-care IBD referral center. Study subjects included all patients age 18 or older with a known diagnosis of IBD, who were admitted at least once between January 1st, 2011 and December 31st, 2012 for a non-elective, IBD-related reason. Hospital billing records were searched using the Research Patient Data Registry. Univariate analysis was performed. A cox proportional hazards model was developed with covariates felt a priori to be related to readmission. Forward selection was performed. Results: 356 patients were admitted at least once during the 2-year study period for an unplanned, IBD-related reason. 208 (58.4%) had CD and 148 (41.6%) had UC. The mean age at time of index admission was 41.7 years (SD +/17). Women accounted for 62% (n = 220). 125 patients had experienced a re-admission by 90 days and no patients were censored prior to 90 days. The initial model contained 19 covariates. Depression and steroid use in the prior 6 months (a marker of active disease) were forced in. After forward selection the final model included four variables, depression (HR=2.06, 1.42-2.98), chronic pain (HR=1.87,1.19-2.94) etoh use (HR=2.43, 1.21-5.29) and Remicade use (HR=1.15, 0.76-1.72).The proportional hazard assumption was then tested on using Martingale residuals for each of the four variables in the final model and all resulted in non-significant p-value. Conclusions: These findings suggests that patients with depression, chronic pain, and who drink alcohol are at greatest risk for a re-admission within 90 days after an initial IBD admission. Disease activity, represented by steroid use in the prior 6 months, was not related to re-admission. Our study identified that comorbid psychiatric disease, chronic pain, and substance abuse are associated with repeat hospitalization. Addressing these problems in the outpatient setting may reduce future hospitalizations in IBD patients. Table 1: Cox Proportional Hazard Model for 90-day Readmission