Unplanned Hospital Readmissions in IBD Patients: Predictive Factors

Abstract

Purpose: Hospitalizations for exacerbations of IBD are common. However, it is unknown which factors are associated with unplanned readmissions in IBD patients. The aim of this study was to determine the predictive factors of unplanned readmissions at 3-mos and 1-yr. Methods: We retrospectively reviewed the electronic database of our institution (3 large academic hospitals) to identify consecutive pts admitted between Jan 2009 to Sept 2010 with primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission during this period. Readmission was defined as unplanned admission (due to any cause) occurring within 3 mos and 1 yr from the index admission. To identify factors predictive of readmissions, we compared social, demographic and clinical features at index admission of pts with readmission and those with no readmissions. The following data was extracted: demographics (age, sex, race, insurance), BMI, tobacco use, source of admission (ED, transfer, direct admit), type of IBD, yrs of disease, surgery prior to index admission, surgery during index admission, medications during index admission and at discharge (antibiotics, steroids, mesalamine, immunomodulators, biologics), colonoscopy, use of TPN, ICU stay, number of comorbities (>3 or <3), history of psychiatric illness. The statistical analysis was done by chi square test and Fisher Exact test. p<0.05 was considered significant. Results: A total of 558 pts with IBD accounted for 1056 admissions within this time period. 209 pts had an index admission with a primary discharge diagnosis of either UC or CD. There were 160 unplanned readmissions. The unplanned readmission rates were-18% at 3 mos and 36.4% at 1 yr. 102 of 209 consecutive pts were analyzed. Their demographic information is:mean age 37.6 yrs, 58% females, 68% Whites, 73 had CD, 29 had UC, mean duration of IBD 8.5 yrs, median length of stay 6 days.24 pts were readmitted at least once within 3 mos and 51 were readmitted at least once within 1 yr. Male sex was predictive of 3-mo readmission (p=0.021) but not 1-yr readmission (p=0.071). None of the other demographic, clinical or social factors analyzed were predictive of either 3-mo or 1-yr readmissions. Conclusion: Based on our results we conclude that despite high rates of both 3-mo and 1-yr unplanned readmissions in IBD patients, there were no demographic, clinical or social factors predictive of unplanned readmissions except male sex. Since frequent admissions are currently deemed to be indicators of poor quality of care, future prospective studies on large number of patients are needed to identify why males are more likely to be readmitted within 3 mos and further help identify modifiable factors to prevent readmissions and thereby conserve healthcare costs. 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.