Unplanned Hospital Readmission Rates and Causes in Patients with Inflammatory Bowel Disease: A Critical Analysis

Abstract

Purpose: IBD is a chronic inflammatory disease characterized by periods of relapses and remissions. Hospitalizations for exacerbations of IBD are common. Readmission has been deemed a marker of poor quality of care. The aim of this study was to better understand and characterize the rates of unplanned readmissions in IBD patients at 30 days, 90 days, 180 days and 1 yr and to identify the reasons for the unplanned readmissions. Methods: We retrospectively reviewed the electronic database of our institution (3 large urban academic hospitals) to identify consecutive patients admitted between Jan 2009 to Sept 2010 with a primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission with primary discharge diagnosis of either UC or CD during this period. Readmission was defined as unplanned admission (due to any cause) occurring within 30 days, 90 days, 180 days or 1 year from the index admission. Data collected included demographics, type of IBD, length of stay, and primary discharge diagnosis for both index and readmission. Results: A total of 558 pts with IBD accounted for 1,056 admissions to the health system within this time period. Of these a total of 209 pts had an index admission with primary discharge diagnosis of either UC or CD. The demographics of the cohort were-mean age 37.5 yrs, 115 females, 149 whites, 150 had CD and 59 had UC. There were a total of 160 unplanned readmissions during the study period. The unplanned readmission rates were - 8.6% (18/209) at 30 days, 18% (37/209) at 90 days, 30.6% (64/209) at 180 days and 36.4% at 1 year. The mean length of stay (LOS) of all index admissions was 7.5 days and mean LOS of all readmissions was 7 days. Among the 76 pts readmitted at least once at 1 year, 38 were females, 47 were whites and 56 pts had CD. At 1 year, 33 pts were readmitted at least twice and 17 were readmitted more than 2 times. Eighty-five of the 160 readmissions had a primary discharge diagnosis of IBD (either CD or UC), while the rest of the 75 had other diagnoses at discharge. Infection was the most common other discharge diagnosis of readmissions (28/160), followed by postoperative complications (10/160), abdominal pain (5/160), bowel obstruction (4/160), pancreatitis (4/160), cholecystitis (4/160). Conclusion: The unplanned readmission rate in IBD pts is high, with more than one third of pts being readmitted at least once within 1 yr of discharge. The most common reasons for readmissions were IBD exacerbations and infections. Future large studies are needed to define national rates of readmission and risk factors for readmissions in IBD pts. This has the potential to better understand and possibly alter the standard of care. Disclosure: Dr. Gary R. Lichtenstein - Consultant: Abbott Corporation, Consultant, Research: Alaven, Research: Bristol-Myers Squibb, Consultant, Research: Centocor Orthobiotech, Consultant: Elan, Consultant, Research: Ferring, Consultant: Hospira, Consultant: Meda Pharmaceuticals, Consultant: Millenium Pharmaceuticals, Consultant: Pfizer Pharmaceuticals, Consultant, Research: Proctor and Gamble, Consultant, Research: Prometheus Laboratories, Inc., Consultant, Research: Salix Pharmaceuticals, Consultant: Santarus, Consultant: Schering-Plough Corporation, Consultant, Research: Shire Pharmaceuticals, Consultant: Takeda, Consultant, Research: UCB, Consultant, Research: Warner Chilcotte, Consultant: Wyeth.