Su1103 30 Day Readmissions Rate and Predictors of Readmission in Hospitalized Patients With Ulcerative Colitis

Abstract

Background: 30 day readmission rates have been evaluated in many diseases and are a measure of quality of care. Currently the Affordable Care Act mandates the Centers for Medicare and Medicaid Services to penalize hospitals with high 30 day readmissions. To date, no study has systematically examined the rates or predictors of readmission in ulcerative colitis (UC). Our goal was to evaluate the overall 30 day rate of readmission and predictors of readmission in patients hospitalized with severe UC. Methods: A total of 720 admissions for severe UC were reviewed from January 2002 to January 2012 at a tertiary care medical center. Charts were reviewed to confirm the diagnosis of UC. Demographic information, admission and discharge date, past medical history, UC related history, medication history prior to admission, during admission, and on discharge, laboratory testing on admission, procedures and surgeries during admission were all assessed. All records were evaluated for readmission within 30 days of the initial hospitalization and the reason for readmission. Readmissions were further evaluated as to whether they were related to UC and if they were pre-planned. Univariate and multivariate analysis was performed using SAS v9.3. Variables with p value <0.1 were included inmultivariate analysis Results: See table 1 for demographics. 15% (109/720) of patients were readmitted within 30 days of their initial admission for a UC. Median length of stay (LOS) of this admit was 4 days. 38% (41/109) were readmitted for a recurrent UC flare or related symptoms, 45% (49/109) were related to UC surgery on the initial admission, 3% (3/109) were planned readmissions. 2% (2/109) of the readmitted patients died. An additional 26% (28/109) were readmitted a second time. The median LOS for this admission was 4 days. Surgery related issues accounted for 54% (15/28) of these readmissions; 18% (5/28) were planned readmissions. On univariate analysis extent of disease involving proctosigmoiditis, or left sided colitis, or extensive colitis, weekend discharge, abdominal x-ray during admission, CT abdomen/pelvis during admission, higher creatinine level on day of admission, use of systemic steroids prior to admission, and surgery during admission all had p values < 0.1. On multivariate analysis, systemic steroids prior to admission (P 0.049), surgery during hospitalization (P <0.005), CT abdomen/pelvis during hospitalization (P 0.012), and higher levels of creatinine on day of admission (P 0.0086) were all significant predictors of readmission (Table 2). Conclusion: UC has a high 30 day rate of readmission. Patients admitted on systemic steroids, have elevated creatinine on admission or undergo surgery during admission should be closely monitored to minimize readmissions. Future studies are necessary to validate predictors of readmission and ways to reduce readmission.