Trends in 30-Day Readmission Rate in Patients With Acute Cholecystitis and Factors Associated With Readmissions

Abstract

Introduction: Acute cholecystitis is a frequent cause of hospitalization in the US. However, the overall burden of readmissions and factors associated with readmissions after having an episode of cholecystitis is unclear. Methods: We interrogated the National Readmissions Database to identify index admissions with primary diagnosis of acute cholecystitis (ICD-9-CM: 575.0) between 2010-2014. Demographic characteristics, hospital factors, comorbidities, and procedural details were obtained. Trends in readmission rates were graphed. Differences in readmission rates based on aforementioned characteristics were computed. Chi-square test was used to assess significance of these differences. Multivariate survey logistic regression analysis was performed to identify factors associated with readmission within 30-days. Results: N=948,804 index hospitalizations had a primary diagnosis of acute cholecystitis. Of these, 8.7% were readmitted with 30 days. A slight but decreasing trend in readmission rate was noted going from 9.2% in 2010 to 8.5% in 2014 (Figure 1). Baseline characteristics and differences these characteristics based on occurrence of 30-day readmission event were computed (Table 1). Being middle aged (45-64 age group), having an admission during a weekend, increasing comorbidity index, and biliary obstruction were all associated with increased odds of readmission within 30 days on the multivariate model. Patients using private insurance/self-pay/other means to pay for their hospital stay, discharge to home without needing home health, and having either cholecystectomy or ERCP were associated with reduced odds of readmissions (Table 2).87_A Figure 1. 30-day Readmission rate After Index Admission for Acute CholecystitisConclusion: Although a fewer portion of patients hospitalized with acute cholecystitis are readmitted within 30 days compared to other causes (14%) the magnitude of readmissions is substantial and represents an opportunity for significant cost savings. Previous analysis demonstrated the benefit of same-admission cholecystectomy with regards to mortality and morbidity. Here, we demonstrate that same-admission ERCP and cholecystectomy are associated with significant reduction in readmission rates also. Additional factors associated with readmissions can inform healthcare policy to help reduce readmission risks.87_B Figure 2. Baseline characteristics & differences in readmission based on patient characteristics87_C Figure 3. Multivariate analysis of factors associated with early readmission