30-day All-cause Readmission Rate Research Articles

The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study.

Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTMimproves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors. Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9thand 10thcodes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems. Of 353,379 discharges for cardiac arrest with 30-day readmission,9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients(6.30% vs. 9.30%, p<0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p<0.001) and AHF (20.13% vs. 17.30%, p<0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p<0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p=0.05) among TTM recipients. Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.

Incidence and 30-and 90-Day Readmission Rates After Primary Shoulder Arthroplasty in the United States: An Analysis using the National Readmissions Database.

The field of shoulder arthroplasty has experienced a substantial increase in the number of procedures performed annually and a shift towards more common implantation of reverse shoulder arthroplasties (RSA). Same day discharge is perceived as beneficial for most patients as well as our healthcare system, and the number of shoulders performed as same day surgery has increase substantially. However, the potential benefits of same day discharge after shoulder arthroplasty may be negatively influenced by unexpected readmissions. As such, an in-depth analysis of readmissions rates after primary shoulder arthroplasty is now particularly timely. The National Readmissions Database was queried for primary shoulder arthroplasty procedures performed in the United States between 2016 and 2018. National incidences were calculated, and indications, patient demographics, comorbidities, facility characteristics, and rates and causes of 30- and 90-day readmissions were determined for all procedures and compared between anatomic total shoulder arthroplasty (TSA), anatomic hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). During the study period, 336,672 primary shoulder arthroplasties were performed (37% TSA, 57% RSA, and 6% hemiarthroplasties (HA). In 2018 national incidences per 100,000 inhabitants were 22.64 for RSA, 12.70 for TSA and 1.50 for HA. The utilization of these procedures between 2016 and 2018 increased for RSA, decreased for HA, and remained constant for TSA, but these changes did not reach statistical significance. The average all-cause 30-day readmission rates were 3.63%, 1.92%, and 3.81% for RSA, TSA, and HA respectively, while the average all-cause 90-day readmission rates were 7.76% (RSA), 4.37% (TSA), and 9.18% (HA). For both RSA and HA, the most common surgical diagnosis for 30-day and 90-day readmission was dislocation (RSA: 0.45% and 0.99%; HA: 0.21% and 0.67%). For TSA, the most common surgical diagnosis for 30-day readmission was infection (0.11%); however, this was surpassed by dislocation (0.28%) at 90-days. RSA surpassed TSA as the most frequently performed shoulder arthroplasty in the United States between 2016 and 2018. In this period, the 90-day readmission rate was not negligible, with dislocation and infection as the leading orthopedic causes of readmission.

Transcatheter versus surgical aortic valve replacement in patients with aortic regurgitation: A propensity-matched analysis

This study aimed to analyze in-hospital and early-to-interim outcomes of pure aortic regurgitation (AR) using transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR). BackgroundFew studies have discussed and compared the safety and short-term prognosis of TAVR and SAVR in pure AR patients. As such, we looked to the National Readmissions Database (NRD) for records between 2016 and 2019 in order to identify patients diagnosed with pure AR who underwent SAVR or TAVR. We used the propensity score matching to minimize disparities between two groups. We included 23,276 pure AR patients: 1983 (8.5%) who underwent TAVR and 21,293 (91.5%) who underwent SAVR. We found 1820 matched pairs using propensity score matching. In the matching cohort, TAVR was associated with a low risk of in-hospital mortality. Although TAVR had lower incidences of 30-day all-cause readmission (hazard ratio (HR):0.73, 95% confidence interval (CI): 0.61–0.87; P < 0.01) and 6-month all-cause readmission (HR: 0.81, 95% CI: 0.67–0.97; P = 0.03), while TAVR had high incidences of 30-day permanent pacemaker implantation incidence (HR: 3.54, 95% CI: 1.62–7.74; P < 0.01) and 6-month permanent pacemaker implantation incidence (HR: 4.12, 95% CI: 1.17–14.4; P = 0.03).In conclusion, TAVR and SAVR had similar risks of hospital death and lower rates of 30-day and 6-month all-cause and cardiovascular readmission. But TAVR had a higher risk of permanent pacemaker implantation than SAVR in AR patients, suggesting that TAVR can be performed safely in pure AR patients.

Comparison of 30-day Readmission Rates and Inpatient Cardiac Procedures for Weekday Versus Weekend Hospital Admissions for Heart Failure

BackgroundWhether the timing of hospital presentation impacts care delivery and clinical outcomes for patients hospitalized for heart failure (HF) remains a matter of debate. In this study, we examined all-cause and HF-specific 30-day readmission rates for patients who were admitted for HF on a weekend vs admitted for HF on a weekday. Methods and ResultsWe conducted a retrospective analysis using the 2010–2019 Nationwide Readmission Database to compare 30-day readmission rates among patients who were admitted for HF on a weekday (Monday to Friday) vs patients who were admitted for HF on a weekend (Saturday or Sunday). We also compared in-hospital cardiac procedures and temporal trends in 30-day readmission by day of index hospital admission. Among 8,270,717 index HF hospitalizations, 6,302,775 were admitted on a weekday and 1,967,942 admitted on a weekend. For weekday and weekend admissions, the 30-day all-cause readmission rates were 19.8% vs 20.3%, and HF-specific readmission rates were 8.1% vs 8.4%, respectively. Weekend admissions were independently associated with higher risk of all-cause (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 1.03–1.05, P < .001) and HF-specific readmission (aOR 1.04, 95% CI 1.03–1.05, P < .001). Weekend HF admissions were less likely to undergo echocardiography (aOR 0.95, 95% CI 0.94–0.96, P < .001), right heart catheterization (aOR 0.80, 95% CI 0.79–0.81, P < .001), electrical cardioversion (aOR 0.90, 95% CI 0.88–0.93, P < .001), or receive temporary mechanical support devices (aOR 0.84, 95% CI 0.79–0.89, P < .001). The mean length of stay was shorter for weekend HF admissions (5.1 days vs 5.4 days, P < .001). Between 2010 and 2019, 30-day all-cause (18.5% to 18.2%, trend P < .001) and HF-specific (8.4% to 8.3%, trend P < .001) readmission rates decreased among weekday HF admissions. Among weekend HF admissions, the HF-specific 30-day readmission rate decreased (8.8% to 8.7%, trend P < .001), but the all-cause 30-day readmission rate remained stable (trend P = .280). ConclusionsAmong patients hospitalized for HF, weekend admissions were independently associated with excess risk of 30-day all-cause and HF-specific readmission and a lower likelihood of undergoing in-hospital cardiovascular testing and procedures. The 30-day all-cause readmission rate has decreased modestly over time among patients admitted on weekdays, but has remained stable among patients admitted on weekends.

Association of Insomnia with 30-Day Postpartum Readmission: A Retrospective Analysis.

Insomnia is prevalent in pregnancy and is associated with increased use of health services. We aimed to evaluate the association between insomnia diagnosed at the delivery hospitalization and risk of 30-day postpartum readmission. We conducted a retrospective analysis of inpatient hospitalizations from the 2010-2019 Nationwide Readmissions Database. The primary exposure was a coded diagnosis of insomnia at delivery as determined by ICD-9-CM and ICD-10-CM codes. Obstetric comorbidities and indicators of severe maternal morbidity were also determined through coding. The primary outcome was all-cause 30-day postpartum readmission. Survey-weighted logistic regression was used to generate crude and adjusted odds ratios representing the association between maternal insomnia and postpartum readmission. Of over 34 million delivery hospitalizations, 26,099 (7.6 cases per 10,000) had a coded diagnosis of insomnia. People with insomnia experienced a 3.0% all-cause 30-day postpartum readmission rate, compared to 1.4% among those without insomnia. After controlling for sociodemographic, clinical, and hospital-level factors, insomnia was associated with 1.64 times higher odds of readmission (95% CI 1.47-1.83). After adjustment for obstetric comorbidity burden and severe maternal morbidity, insomnia was independently associated with 1.33 times higher odds of readmission (95% CI 1.18-1.48). Pregnant patients with insomnia have higher rates of postpartum readmission, and diagnosis of insomnia is independently associated with increased odds of readmission. Additional postpartum support may be warranted for pregnancies affected by insomnia.

30-Day Cardiovascular Readmissions Following Discharge With COVID-19: A US Nationwide Readmission Database Analysis From the Pandemic Year 2020

BackgroundCOVID-19 is known to be associated with a myriad of cardiovascular (CV) complications during acute illness, but the rates of readmissions for CV complications after COVID-19 infection are less well established. MethodsThe US Nationwide Readmission Database was utilized to identify COVID-19 admissions that occurred in the period from April 1st to November 30th, 2020, using International Classification of Diseases, 10th edition, Clinical Modification administrative claims. ResultsA total of 521,351 admissions for COVID-19 were identified. The all-cause 30-day readmission rate was 11.6% (n = 60,262). The incidence of CV-related readmissions was 5.1% (n = 26,725), accounting for 44.3% of all-cause 30-day readmissions. Both CV-related and non-CV-related readmissions occurred at a median of 7 days. Patients readmitted with CV causes had a higher comorbidity burden, with a median Charlson comorbidity score of 6. The most common CV cause of readmission was acute heart failure (8.5%), followed by acute myocardial infarction (5.2%). Venous thromboembolism and stroke during 30-day readmission occurred at rates of 4.6% and 3.6%, respectively. Stress cardiomyopathy and acute myocarditis were less frequent, with incidences of 0.1% and 0.2%, respectively. CV-related readmissions were associated with higher mortality, compared with non-CV-related readmissions (16.5% vs 7.5%, P < 0.01). Each 30-day CV-related readmission was associated with greater cost of care than each non-CV-related readmission ($13,803 vs $10,310, P < 0.01). ConclusionsAmong survivors of index COVID-19 admission, 44.7% of all 30-day readmissions were attributed to CV causes. Acute heart failure remains the most common cause of readmission after COVID-19, followed closely by acute myocardial infarction. CV causes of readmissions remain a significant source of mortality, morbidity, and resource utilization.

Multidimensional Interventions on Supporting Disease Management for Hospitalized Patients with Heart Failure: The Role of Clinical and Community Pharmacists.

existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on supporting disease management for hospitalized patients with heart failure (HF). The present paper reviews the effects of inpatient, discharge and/or after-discharge interventions performed on hospitalized HF patients by multidisciplinary teams, including pharmacists. articles were identified through search engines in three electronic databases following the PRISMA Protocol. Randomized controlled trials (RCTs) or non-randomized intervention studies conducted in the period 1992-2022 were included. In all studies, baseline characteristics of patients as well as study end-points were described in relation to a control group i.e., usual care and a group of subjects that received care from a clinical and/or community pharmacist, as well as other health professionals (Intervention). Study outcomes included all-cause hospital 30-day re-admission or emergency room (ER) visits, all-cause hospitalization within >30 days after discharge, specific-cause hospitalization rates, medication adherence and mortality. The secondary outcomes included adverse events and quality of life. Quality assessment was carried out using RoB 2 Risk of Bias Tool. Publication bias across studies was determined using the funnel plot and Egger's regression test. a total of 34 protocols were included in the review, while the data from 33 trials were included in further quantitative analyses. The heterogeneity between studies was high. Pharmacist-led interventions, usually performed within interprofessional care teams, reduced the rates of 30-day all-cause hospital re-admission (odds ratio, OR = 0.78; 95% CI 0.62-0.98; p = 0.03) and all-cause hospitalization >30 days after discharge (OR = 0.73; 95% CI 0.63-0.86; p = 0.0001). Subjects hospitalized primarily due to heart failure demonstrated reduced risk of hospital admission within longer periods, i.e., from 60 to 365 days after discharge (OR = 0.64; 95% CI 0.51-0.81; p = 0.0002). The rate of all-cause hospitalization was reduced by multidimensional interventions taken by pharmacists: reviews of medicine lists and/or their reconciliation at discharge (OR = 0.63; 95% CI 0.43-0.91; p = 0.014), as well as interventions that were based mainly on patient education and counseling (OR = 0.65; 95% CI 0.49-0.88; p = 0.0047). In conclusion, given that HF patients often have complex treatment regimens and multiple comorbid conditions, our findings highlight the need for greater involvement from skilled clinical and community pharmacists in disease management.

30-day readmission rates among upper gastrointestinal bleeds: A systematic review and meta-analysis.

Upper gastrointestinal bleeding (UGIB) is a common emergency, with high rates of hospitalization and in-patient mortality compared to other gastrointestinal diseases. Despite readmission rates being a common quality metric, little data are available for UGIBs. This study aimed to determine readmission rates for patients discharged following an UGIB. Adhering to PRISMA guidelines, MEDLINE, Embase, CENTRAL, and Web of Science were searched to October 16, 2021. Randomized and non-randomized studies that reported hospital readmission for patients following an UGIB were included. Abstract screening, data extraction, and quality assessment were conducted in duplicate. A random-effects meta-analysis was performed, with statistical heterogeneity measured using I2 . The GRADE framework, with a modified Downs and Black tool, was used to determine certainty of evidence. Seventy studies were included of 1847 screened abstracted, with moderate interrater reliability. Within these studies, 4292714 patients were analyzed with a mean age of 66.6years, and 54.7% male. UGIB had a 30-day all-cause readmission rate of 17.4% (95% confidence interval [CI] 16.7-18.2%), stratification revealed a higher rate for variceal UGIB [19.6% (95% CI 17.6-21.5%)] than non-variceal [16.8% (95% CI 16.0-17.5%)]. Only one third were readmitted due to recurrent UGIB (4.8% [95% CI 3.1-6.4%]). UGIB due to peptic ulcer bleeding had the lowest 30-day readmission rate [6.9% (95% CI 3.8-10.0%)]. Certainty of evidence was low or very low for all outcomes. Almost one in five patients discharged after an UGIB are readmitted within 30days. These data should prompt clinicians to reflect on their own practice to identify areas of strength or improvement.

Dementia and readmission risk in patients with heart failure participating in a transitional care program

BackgroundCognitive impairment is prevalent in patients hospitalized for heart failure (HF). We aimed to generate further evidence on the value of dementia screening in hospitalized HF patients by examining whether and when dementia would be an independent risk factor for 30-day readmission while modeling permutations of known risk factors such as patient demographics, disease burden, prior utilization, and index hospitalization characteristics. Methods and resultsA retrospective cohort study was employed, consisting of 26,128 patients (2,075 or 7.9% with dementia) in a transitional care program post HF hospitalization. The overall 30-day all-cause readmission rate was 18.1%. Patients with dementia had higher unadjusted rates of readmission (22.0 vs 17.8%) and death (4.5 vs. 2.2%) within 30 days post hospitalization, compared to those without dementia. Hierarchical multivariable proportional hazards regression results showed that dementia independently predicted readmission when both patient demographics and disease burden variables were controlled for (HR=1.15, p=0.02). However, the association between dementia and readmission was attenuated in the full model when prior utilization and index hospitalization characteristics were added (HR=1.04, p=0.55). For dementia patients, Charlson comorbidity index, prior ED visits, and length of stay were significant risk factors of readmission. ConclusionsThe presence of dementia and the predictors of 30-day readmission in those with dementia may help identify this subset of high-risk HF patients for potential efforts to improve their prognosis.

Discharge disposition and clinical outcomes of patients hospitalized with COVID-19

ObjectivesBy better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. MethodsA retrospective chart review was performed of adult patients with a positive COVID-19 polymerase chain reaction test among multiple hospitals in a regional health system. The main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30 and 90 days of discharge. ResultsOf the 2502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30 and 90 days were 2.7% and 4.4%, respectively. The overall all-cause 30-day and 90-day readmission rates were 7.0% and 7.6%, respectively. ConclusionYounger age and shorter hospitalization stays were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30 and 90 days after discharge.

Abstract 157: Association Of Hospital Performance With 1-Year Mortality And Recurrence After Ischemic Stroke Among US Medicare Beneficiaries

Background: Whether stroke patients treated at hospitals with better short-term quality performance metrics have better long-term outcomes is unknown. We determined if ischemic stroke patients treated at US hospitals with better past performance on the Centers for Medicare &amp; Medicaid Services (CMS) 30-day mortality and readmission outcome measures for stroke had better 1-year outcomes compared to those treated at other hospitals. Methods: We included all Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital’s performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission rate measures for stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were &lt;25 th percentile of national rates), High-High (both &gt;75 th percentile), and Intermediate (all others). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models to assess patient risks of 1-year mortality and recurrent stroke across hospital performance categories, weighted by the IPW and accounting for competing risks. Results: There were 595,929 stroke patients (mean age 78.9y, 54.4% women, 82.2% White) discharged from 134 Low-Low, 2288 Intermediate, and 141 High-High hospitals. For patients treated at Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% CI 23.3-24.3%), 25.2% (25.1-25.3%), and 26.5% (26.1-26.9%), and recurrence rates were 8.0% (7.6-8.3%), 7.9% (7.8-8.0%), and 8.0% (7.7-8.3%). Compared with patients at High-High hospitals, those at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82-0.87) and 9% (0.91; 0.89-0.93) lower risks of 1-year mortality but no difference in 1-year recurrence. Conclusions: Ischemic stroke patients treated at better-performing hospitals had lower risks of post-discharge 1-year mortality but similar risks of recurrent stroke compared with patients treated at other hospitals.

Comparison of Hospitalization and Post-Hospitalization Outcomes among Family Medicine Hospitalists and Internal Medicine Hospitalists in a Tertiary Center: A Prospective Cohort Study

Background: There is a lack of studies comparing hospitalization and post-hospitalization outcomes between internal medicine (IM) hospitalists and family medicine (FM) hospitalists. &#x0D; Objective: To compare the length of stay (LOS), hospital cost, and 30-day all-cause readmission rate among patients treated by IM hospitalists and FM hospitalists. &#x0D; Design and Setting: Prospective cohort study in a referral center. Propensity score matching was used to balance baseline characteristics between comparative arms.&#x0D; Participants: 747 patients 18 years and older who were admitted to hospitalist services.&#x0D; Intervention: Treatment by IM hospitalists and FM hospitalists.&#x0D; Main Measures: LOS, hospital cost, and 30-day all-cause readmission. Treatment arms were compared by two methods. We compared patients who were seen by FM exclusively with those treated exclusively by IM services. Covariate adjusted differences in outcomes were estimated by multivariable regression. For a secondary set of analyses, exposure to FM and IM was converted to a continuous independent variable.&#x0D; Key Results: Forty, 333, and 374 patients were seen by FM, IM, and a combination of both services, respectively. Using average treatment on the treated as the estimand, FM care provided a shorter weight-adjusted LOS by 0.5 days (CI: -0.92- -0.04, P =0.026) compared to IM, but no difference in hospital cost (-126, CI: -906-653, P=.74). There was no difference in adjusted hazard for 30-day readmission between FM and IM (HR: 2, CI: 0.67-6.2, P =0.062). Propensity weight-adjusted multiple regression models of the complete cohort (n=747) did not show any difference in any outcomes with increased exposure to FM care. &#x0D; Conclusions: Understanding variation in practices and outcomes between different hospitalist models opens opportunities to improve care and decrease the length of stay.

Impacto del seguimiento precoz desde atención primaria en el reingreso a 30 días tras el alta hospitalaria por insuficiencia cardiaca

IntroductionReducing heart failure (HF) admissions is one of the main objectives in disease control, due to its impact on prognosis and costs. The transitional models at discharge are imposed as a strategy capable of reducing hospitalizations, most of them based on specific hospital units. We analyzed the impact of the primary care (PC) post-discharge follow-up. Material and methodsRetrospective observational study at the referral area of a tertiary hospital. Linear regression analysis was performed between early follow-up from the PC center after HF admission rate and the 30-day all-cause readmission rate throughout 2021. ResultsThe degree of follow-up from PC after hospital discharge for heart failure is associated with fewer 30-day readmissions for all causes (Pearson's R=0.53, P=.02); with a decrease of 20%, similar to that observed when it is performed from other care facilities and which is maintained when adjusting for the complexity of the patients. ConclusionsPC heart failure post-discharge follow-up could be effective in reducing hospitalizations, and is complementary to that carried out by hospital units.

An evaluation of risk factors for readmission in patients receiving outpatient parenteral antimicrobial therapy.

Outpatient parenteral antimicrobial therapy (OPAT), when required, is beneficial to patients and healthcare systems by reducing hospital length-of-stay, providing cost savings, and improving patient satisfaction. The purpose of this study is to determine readmission rates and associated risk factors in patients receiving OPAT at home. This retrospective study included hospitalized patients 15 years and older who were discharged on intravenous antimicrobial therapy via OPAT at home between January 2018 and December 2019. Patients receiving antimicrobials at a skilled nursing facility, long-term acute care, or dialysis center, and those who began OPAT at home directly from the outpatient setting were excluded. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 90-day readmission rate, rates of complications related to OPAT, emergency department visits during OPAT, and predictors of all-cause 30-day readmission through a logistic regression analysis. Two hundred individual patients were included in the analysis; 60% were male and the mean age was 49 years. The most common indications for OPAT at home were bone and joint infection (52%) and bacteremia (26%). Forty patients (20%) experienced an unplanned, all-cause 30-day readmission, with a total of 48 readmission events. Of the 40 patients who were readmitted within 30 days, 20 (50%) were due to non-OPAT related reasons. Sixty patients (30%) experienced an OPAT-related complication, and chronic kidney disease was found to be an independent predictor of readmission (OR: 2.8, 95% CI: 1.0-7.6). Patients receiving OPAT at home are at increased risk for early hospital readmission, but it is often due to reasons not associated with OPAT. Patients with chronic kidney disease beginning OPAT at home should be closely monitored after discharge.

998. Clinical Outcomes and Cost Savings of Dalbavancin Use in OPAT: Focus on Complicated Staphylococcus aureus Infections

Abstract Background The practical and financial benefits of long-acting glycopeptides are increasingly recognized, and their efficacy is becoming better established for a variety of indications. Dalbavancin use as primary therapy for complicated Staphylococcus aureus (cSA) infections, however, has only been described in small case series to this point. Methods This retrospective review identified patients prescribed dalbavancin for any indication and followed by the Nebraska Medicine OPAT team since program implementation (4/1/19 - 4/30/22). Patients in the cSA infection subgroup were defined by need for &amp;gt;2 weeks of treatment for a Staphylococcus aureus infection involving bacteremia. Dalbavancin as primary therapy for cSA was defined as initiation of dalbavancin within the first 10 days of antibiotic therapy and continued through the end of treatment. The primary clinical outcome was 30-day readmission rate (both infection-related and not infection-related). Results A total of 66 patients were prescribed dalbavancin for treatment of any infection (Table 1), with an all-cause 30-day readmission rate of 13.6% (9 of 66); only two of these were infection-related (3%). Updating a prior institutional analysis, use of dalbavancin led to the avoidance of 506 planned inpatient days per year on average and $1,113,000 in yearly inpatient costs. Dalbavancin was utilized for primary therapy of cSA in 16 patients, of whom only one (6.3%) had a 30-day readmission, due to progression of cSA vertebral osteomyelitis-discitis. Table 1:Characteristics of the Dalbavancin Cohort Conclusion In both overall and cSA subgroup analysis, OPAT use of dalbavancin was associated with low readmission rates. This study is the largest to date suggesting favorable clinical outcomes with dalbavancin as primary therapy for cSA infections; others have reported few of these patients or utilized dalbavancin exclusively as consolidation therapy following significant lead-in with other antimicrobials. The enrolling Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia study (DOTS; NCT04775953) is anticipated to provide randomized controlled data evaluating this approach. Discharge facilitation utilizing dalbavancin contributed significantly to OPAT program cost justification and resources to support team expansion. Disclosures Bryan T. Alexander, PharmD, BCIDP, AAHIVP, Astellas Pharma: Advisor/Consultant Scott J. Bergman, PharmD, BCIDP, FCCP, FIDSA, Merck &amp; Co., Inc: Advisor/Consultant|Merck &amp; Co., Inc: Grant/Research Support|Merck &amp; Co., Inc: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.

Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters

BackgroundTelemedicine use increased dramatically during the COVID-19 pandemic; however, questions remain as to how telemedicine use impacts care. ObjectivesThe purpose of this study was to examine the association of increased telemedicine use on rates of timely follow-up and unplanned readmission after acute cardiovascular hospital encounters. MethodsWe examined hospital encounters for acute coronary syndrome, arrhythmia disorders, heart failure (HF), and valvular heart disease from a large U.S., multisite, integrated academic health system among patients with established cardiovascular care within the system. We evaluated 14-day postdischarge follow-up and 30-day all-cause unplanned readmission rates for encounters from the pandemic “steady state” period from May 24, 2020 through December 31, 2020, when telemedicine use was high and compared them to those of encounters from the week-matched period in 2019 (May 26, 2019, through December 31, 2019), adjusting for patient and encounter characteristics. ResultsThe study population included 6,026 hospital encounters. In the pandemic steady-state period, 40% of follow-ups after these encounters were conducted via telemedicine vs 0% during the week-matched period in 2019. Overall, 14-day follow-up rates increased from 41.7% to 44.9% (adjusted difference: +2.0 percentage points [pp], 95% CI: −1.1 to +5.1 pp, P = 0.20). HF encounters experienced the largest improvement from 50.1% to 55.5% (adjusted difference: +6.5 pp, 95% CI: +0.5 to +12.4 pp, P = 0.03). Overall 30-day all-cause unplanned readmission rates fell slightly, from 18.3% to 16.9% (adjusted difference −1.6 pp; 95% CI: −4.0 to +0.8 pp, P = 0.20). ConclusionsIncreased telemedicine use during the COVID-19 pandemic was associated with earlier follow-ups, particularly after HF encounters. Readmission rates did not increase, suggesting that the shift to telemedicine did not compromise care quality.

Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting.

Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through2019. In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.

Single-dose intravenous ketamine or intramuscular naltrexone for high-utilization inpatients with alcohol use disorder: pilot trial feasibility and readmission rates

BackgroundAlcohol use disorder (AUD) accounts for millions of acute care encounters annually in the United States. Hospitalization represents a vital opportunity to intervene pharmacologically, but low medication adherence is a significant barrier. Two single-dose, adherence-independent interventions are well suited for pre-discharge administration: intravenous (IV) ketamine and intramuscular (IM) naltrexone. Their feasibility and readmission-reducing efficacy in hospital settings are not well-established.MethodsA 3-arm, open-label randomized trial was conducted at our safety-net medical hospital among high-utilization inpatients with severe AUD. Consented adults (age 18–65) were randomized to (1) IV ketamine (KET) 0.5 mg/kg over 40 min, (2) IM naltrexone (NTX) 380 mg once, or (3) linkage alone (LA). The primary clinical outcome was 30-day all-cause hospital readmission rate. All were provided enhanced linkage to outpatient addiction clinic.ResultsWe consented and randomized 44 participants (n = 13, 14, 17 for KET, NTX, LA, respectively), with a mean of 3.2 past-year hospitalizations. Compared to the LA arm, both the KET arm (RR 0.37, p = 0.17) and NTX arm (RR 0.52, p = 0.27) had a lower 30-day readmission rate, though the differences were nonsignificant. Immediate acceptability ratings of KET and NTX were 9.50 and 9.17 out of 10, respectively. No serious adverse events or illicit ketamine use was reported.ConclusionsBoth interventions are feasible and showed promise in reducing readmissions for high-utilization AUD inpatients. Despite randomization, baseline characteristics may have differed in ways that biased against the control arm. Additional pragmatic studies—with larger sample size, blinding, and robust follow-up data collection—are needed to verify findings and better understand mediating factors.ClinicalTrials.gov Identifier NCT04562779. Registered 24 September 2020. https://clinicaltrials.gov/ct2/show/NCT04562779

Clinical Outcomes of Oral Zinc Therapy in Hepatic Encephalopathy Treatment.

Additional therapies for hepatic encephalopathy (HE) treatment are warranted. There are data evaluating the use of zinc for HE; however, clinical outcomes, specifically in the United States, are unknown. To compare 30-day and 1-year all-cause readmission rates in patients with cirrhosis complicated by HE on lactulose and rifaximin to those on lactulose, rifaximin, and zinc. This retrospective study included patients admitted with documented cirrhosis and home medications of lactulose and rifaximin, with or without zinc. Patients were stratified into 2 groups: those receiving lactulose and rifaximin for HE (control) and those receiving lactulose, rifaximin, and zinc for HE (treatment). The primary outcomes were 30-day and 1-year all-cause readmission rates. One-hundred fifty-seven patients were included (102 in control group, 55 in treatment group). Regarding 30-day and 1-year all-cause readmission rates, there was no difference between the control and treatment groups. This is the first study conducted in the United States evaluating zinc for HE treatment. Zinc did not impact 30-day or 1-year all-cause readmission rates. Further studies are warranted to evaluate the potential benefit of zinc for HE, possibly in correlation with Model for End-stage Liver Disease-Sodium (MELD-Na) scores.

Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016-2019 national readmission database.

The safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients. In this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients (n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only (n = 407, 5.3%) or CA-only patients (n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%). We report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients.