30-day Readmission Rates For Patients Research Articles

Impact of altered mental status on antibiotic prescribing and outcomes in hospitalized patients presenting with pyuria

BackgroundPyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance. ObjectivesThe purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes. MethodsThis retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia. ResultsTwo-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing. ConclusionsInappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis.

Heart failure drug classes and 30-day unplanned hospital readmission among patients with heart failure in Ethiopia

BackgroundDrug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure.MethodA multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI).ResultsIn this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission.ConclusionElderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

TCT-510 All-Cause 30-Day Readmission Rates in Patients Undergoing Transcatheter Aortic Valve Replacement

Impact of Podiatric Surgery Consultation for Foot and Ankle Wounds on Patient Outcomes in a Community Hospital

Previous studies have demonstrated that timely podiatric surgery consultation results in positive patient outcomes. However, there are limited studies focused on readmission rates in teaching community hospitals. The primary aim of this study is to determine if consulting podiatric services was associated with lower 30-day readmission rates and impact on length of stay in patients with lower extremity wounds. The secondary aim was to investigate medical and socio-economic factors associated with better outcomes. This study was a cross-sectional descriptive study. A retrospective chart review utilizing the hospital's electronic medical record system identified patients with lower extremity wounds (based on ICD-10 codes) admitted between July 2018 and December 2020. The results showed a 3-fold decrease in 30-day readmission rates in patients with podiatric surgery consultation compared to patients without consultation with lower extremity wounds (4.2% vs 11.3%, p=.03). Multivariate regression models showed patients with gangrene (AOR=7.61; p=.04) or osteomyelitis (AOR=9.07; p=.013) had a higher likelihood of readmission than patients with venous ulcer (reference category) after controlling for podiatric consultation. Among the group of patients with podiatric consultation, earlier podiatric consultations resulted in decreased length of stay. This study identifies prior amputation history and lack of podiatric consultation increased 30-day readmission rates.

Discharge Against Medical Advice After Hospitalization for Sepsis: Predictors, 30-Day Readmissions, and Outcomes

BackgroundSepsis is a leading cause of death worldwide. However, little has been known concerning the status of discharge against medical advice (DAMA) in sepsis patients. ObjectiveTo identify factors associated with DAMA, evaluate the association of DAMA with 30-day unplanned readmission and readmitted outcomes after sepsis hospitalization. MethodsUsing the National Readmission Database, we identified sepsis patients who discharged routinely or DAMA in 2017. Multivariable models were used to identify factors related to DAMA, evaluate the association between DAMA and readmission, and elucidate the relationship between DAMA and outcomes in patients readmitted within 30 days. ResultsAmong 1,012,650 sepsis cases, patients with DAMA accounted for 3.88% (n = 39,308). The unplanned 30-day readmission rates in patients who discharged home and DAMA were 13.08% and 27.21%, respectively. Predictors of DAMA in sepsis included Medicaid, diabetes, smoking, drug abuse, alcohol abuse, and psychoses. DAMA was statistically significantly associated with 30-day (odds ratio [OR] 2.18, 95% confidence interval [CI] 2.09–2.28), 60-day (OR 1.98, 95% CI 1.90–2.06), and 90-day (OR 1.88, 95% CI 1.81–1.96) readmission. DAMA is also associated with higher mortality in patients readmitted within 30 days (OR 1.38, 95% CI 1.17–1.63), whereas there were no statistically significant differences in length of stay and costs between patients who discharged home or DAMA. ConclusionsDAMA occurs in nearly 3.88% of sepsis patients and is linked to higher readmission and mortality. Those at high risk of DAMA should be early identified to motivate intervention to avoid premature discharges and associated adverse outcomes.

Factors associated with readmission to the same hospital within 30 days of discharge in patients who received surgical treatment for head and neck cancer: An NCDB analysis.

e18570 Background: Readmission rates within 30-days of discharge is an important quality metric when caring for hospitalized patients. Higher rates of readmission are a predictor of all-cause mortality and associated with negative financial implications for hospitals. Patients undergoing surgery for the treatment of head and neck cancer have readmission rates ranging from 7.3% to 26.5%. The benefits to the patient and the hospital highlight the importance of determining if certain patient features impact the likelihood of readmission. This study sought to determine if certain socioeconomic and demographic factors are associated with higher 30-day readmission rates following surgically treated head and neck cancers. Methods: Using the National Cancer Database, 221,822 patients were identified as having surgically treated head and neck cancer between 2004 and 2020. Using SPSS statistics 28, 30-day readmission rates for these patients were compared to each other based on certain characteristics including sex, race, ethnicity, insurance status, income, and facility type. Results were analyzed using descriptive statistics, a multivariate binary logistic regression, and chi-square analyses using a significance level of p &lt; 0.05. Results: Higher 30-day readmission rates in patients with certain demographic and socioeconomic factors were identified. Black and Asian patients had higher readmission rates in comparison to white patients (p &lt; .001, 95% CI = 1.24-1.41 and 1.08-1.30, respectively). Patients of Hispanic backgrounds were 25% more likely to be readmitted than non-Hispanic patients (p &lt; .001, 95% CI = 1.15-1.34). Males had a 13% higher readmission rate than females (p &lt; .001, 95% CI = 1.09-1.17). Uninsured patients were more likely to be readmitted than those with some form of insurance (p &lt; .001). Those with a median annual income less than $46,277 were 11% more likely to be readmitted than those who had a median annual income higher than $46,277 (p &lt; .001). In comparison to those treated at a community cancer program, patients who received treatment at academic/research programs or integrated network cancer programs were 32% and 21% more likely to be readmitted, respectively (p &lt; .001, 95% CI = 1.20-1.45 and 1.10-1.34, respectively). Conclusions: Patients who are more likely to be readmitted to the same hospital within 30-days of being surgically treated for head and neck cancers include black patients, Asians, those of Hispanic descent, males, the uninsured, those with a lower median annual income, and those who received surgical treatment at academic/research programs or integrated network cancer programs. Identification of factors contributing to readmission allows for development of targeted interventions to prevent this occurrence.

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.

B-44 | 30-Day Readmission Rates of Transcatheter Aortic Valve Replacement in Underlying Obstructive vs Restrictive Pulmonary Diseases

Our objective is to compare the 30-day readmission rates for patients undergoing transcatheter aortic valve replacement (TAVR) with underlying obstructive and restrictive pulmonary diseases. We conducted a retrospective cohort analysis using National Readmission Databases 2016-2018 with ICD-10 codes. Primary outcome was readmission rates for patients hospitalized for TAVR with and without underlying chronic pulmonary diseases (CPD). 30-day readmission rate was higher for TAVR patients with CPD as compared to patients without CPD (14.7% vs 11.6%) (Table 1). Mortality rate is also higher in TAVR index admissions with CPD as compared to without CPD (19% vs 13.8%) and also for TAVR 30-day readmissions (4.1% vs 3.6%). Table 2 summarizes the most common principal diagnosis for 30-day readmissions for TAVR Patients with chronic pulmonary disease (CPD). TAVR patients with restrictive pulmonary disease have higher 30-day readmission rate than obstructive pulmonary disease (18.8% vs 14.5%). Among the obstructive pulmonary disease, TAVR patients with underlying bronchiectasis have highest 30-day readmission rate (17.8%) while among restrictive pulmonary disease, TAVR patients with underlying hypersensitivity pneumonitis have the highest 30-day readmission rate (22.3%). TAVR patients with underlying CPD have higher readmission rates, mortality rates, mean length of stay, and mean total charges as compared to patients without CPD. TAVR patients with underlying restrictive pulmonary disease have higher readmission rates than obstructive pulmonary disease.

30-day Readmission Rates In Patients With Premature Heart Failure With Preserved Ejection Fraction

30-day Readmission Rates In Patients With Premature Heart Failure With Preserved Ejection Fraction

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Coexisiting Amyloidosis: Mortality, Stroke, and Readmission

BackgroundCardiac amyloidosis can coexist in patients with severe aortic stenosis. There are limited outcomes data on whether this impacts the risk of transcatheter aortic valve replacement (TAVR). ObjectivesThe authors aimed to investigate the effect of amyloidosis on outcomes of TAVR. MethodsWe used the Nationwide Readmissions Database to identify hospitalizations for TAVR between 2016 and 2019. The presence of a diagnosis of amyloidosis was identified. Propensity score-weighted regression analysis was used to identify the association of amyloidosis with in-hospital mortality, acute ischemic stroke, and 30-day readmission rate after TAVR. ResultsWe identified 245,020 hospitalizations for TAVR, including 273 in patients with amyloidosis. The mean age was 79.4 ± 8.4 years. There was no difference in in-hospital mortality or 30-day readmission rate in patients with and without amyloidosis (1.8% vs 1.5%, P = 0.622; and 12.9% vs 12.5%, P = 0.858; respectively). However, there was a higher rate of acute ischemic stroke in patients with amyloidosis (6.2% vs 1.8%, P < 0.001). Propensity score-weighted logistic regression analysis showed the presence of amyloidosis was associated with greater odds of acute ischemic stroke (odds ratio: 3.08, 95% CI: 1.41-6.71, P = 0.005), but no difference in mortality (odds ratio: 0.79, 95% CI: 0.28-2.27, P = 0.666) or 30-day readmission rate after TAVR (HR: 0.72, 95% CI: 0.41-1.25, P = 0.241). ConclusionsThis analysis suggests amyloidosis may be associated with a higher thromboembolic risk after TAVR that merits further investigation.

Meds to Beds at Hospital Discharge Improves Medication Adherence and Readmission Rates in Select Populations.

Medication nonadherence caused by difficulty obtaining and paying for medicines can increase hospital readmissions. This project implemented Medications to Beds ("Meds to Beds," M2B), a multidisciplinary predischarge medication delivery program, at a large urban academic hospital that provided subsidized medications for uninsured and underinsured patients to reduce readmissions. This 1-year retrospective analysis of patients discharged from the hospitalist service after implementing M2B contained two groups: one with subsidized medications (M2B-S) and one with unsubsidized medications (M2B-U). Primary analysis was 30-day readmission rates for patients, stratified by Charlson Comorbidity indexes (CCIs) of 0, 1-3, ≥4 to represent low, medium, and high comorbidity burden. Secondary analysis included readmission rates by Medicare Hospital Readmission Reduction Program diagnoses. Compared with controls, the M2B-S and M2B-U programs had significantly reduced readmission rates among patients with CCIs of 0 (10.5% [controls] vs 9.4% [M2B-U] and 5.1% [M2B-S], P < 0.05). A nonsignificant reduction occurred in readmissions for patients with CCIs ≥4 (20.4% [controls] vs 19.4% [M2B-U] vs 14.7% [M2B-S], P < 0.07). Patients with CCIs of 1 to 3 showed a significant increase in readmission rates in the M2B-U, but a decrease in readmission rates among the M2B-S (15.4% [controls] vs 20% [M2B-U] vs 13.1% [M2B-S], P < 0.05). Secondary analyses found no significant differences in readmission rates when patients were stratified by Medicare Hospital Readmission Reduction Program diagnosis. Cost analyses demonstrated that subsidizing medicines cost less per patient for every 1% readmission reduction than delivery alone. Providing medicine to patients predischarge tends to lower readmission rates for populations with no comorbidities or with a high burden of disease. This effect is amplified when prescription costs are subsidized.

IDF2022-1038 The Impact of Hospital Readmission Reduction Program on 30-Day Readmission Rates in Patients with Diabetes Mellitus

IDF2022-1038 The Impact of Hospital Readmission Reduction Program on 30-Day Readmission Rates in Patients with Diabetes Mellitus

1386. Prescribing Patterns of Skin and Soft Tissue Infections in Patients Discharged from the Emergency Department

Abstract Background Treatment of skin and soft tissue infections (SSTIs) are a growing reason for Emergency Department (ED) visits. Inadequate treatment of SSTIs has been reported in up to 25% of patients treated in ED. The purpose of this project was to describe prescribing patterns for SSTIs from the ED. Methods Single center retrospective cohort study of SSTI patients discharged from ED between July 1- December 31, 2020. The primary outcome was to describe the proportion of patients receiving guideline directed therapy (GDT) for SSTIs. Secondary outcomes include describing the proportion of patients readmitted within 30 days, the reason for readmission, and to compare 30-day readmission rates in patients who received GDT versus non-GDT. Results Of 876 patients screened, 576 were excluded primarily for being admitted to the hospital. Of the 300 included patients, 117 (39%) received GDT and 183 (61%) received non-GDT. Fifty-six of 300 patients were readmitted within 30 days, of which 21 (17.9%) had received GDT and 35(19.1%) had received non-GDT (p=0.8). Readmissions related to persistence or progression of SSTI were not significantly different between GDT and non-GDT, 9 patients and 11 patients respectively (p=0.57). The remaining 36 patients (64.3%) were readmitted for reasons unrelated to SSTI. Conclusion The majority of prescribed antibiotic therapy for SSTI did not conform to GDT. However, 30-day readmission rates were not significantly different between the groups. Further research on GDT and ED treated SSTI is needed. Disclosures All Authors: No reported disclosures.

2244. Prescribing Patterns of Urinary Tract Infections in Patients Discharged from the Emergency Department

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in the emergency department (ED). The risk of treatment failure and readmissions to the ED may be increased with inappropriate antibiotic regimens. The purpose of this project is to determine the proportion of patients receiving guideline-based therapy (GBT) for UTI discharged from the ED. Methods Single-center, retrospective cohort study of adult patients diagnosed with an UTI or pyelonephritis from July 1-December 31, 2020. The primary outcome was to describe the proportion of patients discharged from the ED who received GBT for UTI. Secondary outcomes were to define the proportion of patients readmitted within 30 days, describe the reason for readmission, and compare 30-day readmission rates in patients who received GBT versus non-GBT. Results Of 370 patients screened, 68 were excluded primarily for inpatient admission. Of the 302 patients included, 172 (57%) received GBT and 130 (43%) received non-GBT with no significant difference in Charlson Comorbidity Index (p= 0.48) between groups. Fifty two of 302 patients (17.2%) were readmitted within 30 days; 31 (60%) from GBT and 21 (40%) from non-GBT (p=0.632). Of the 52 readmissions, 14 (26.9%) were related to the UTI and returned for either persistent symptoms (11 patients) or development of sepsis (3 patients). Readmissions related to persistence of UTI and development of sepsis were not significantly different between GBT and non-GBT, 9 patients and 5 patients respectively (p=0.92). Conclusion The majority of prescribed antibiotic therapy did conform to GBT for UTI. However, 30-day readmission rates were not significantly different between groups. Disclosures All Authors: No reported disclosures.

OR11-5 Outcomes and Predictors of 30-day Readmission for Hyperthyroidism: A Nationwide Study

Abstract This retrospective cohort study examines the 30-day readmission rate for patients with hyperthyroidism. Analysis of data from the 2018 Nationwide Readmissions Database exposed factors that affect this rate and described key healthcare quality indices that are associated with these readmissions. Understanding these will help identify areas for improving patient outcomes. Presentation: Sunday, June 12, 2022 12:00 p.m. - 12:15 p.m.

Corrections.

Corrections| October 01 2022 Corrections Crit Care Nurse (2022) 42 (5): 7. https://doi.org/10.4037/ccn2022699 Connected Content Companion: Critical Care Nurse: Decreasing 30-Day Readmission Rates in Patients With Heart Failure Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Cite Icon Cite Get Permissions Citation Corrections. Crit Care Nurse 1 October 2022; 42 (5): 7. doi: https://doi.org/10.4037/ccn2022699 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentCritical Care Nurse Search Advanced Search In the article “Decreasing 30-Day Readmission Rates in Patients With Heart Failure” by Rizzuto et al (Crit Care Nurse. 2022;42[4]:13-19), the sentence on page 17 about the 30-day readmission rate decrease should read: “After implementation, the 30-day readmission rate decreased to 12% in the pilot program.” You do not currently have access to this content.

S866 Malnutrition and Opioid Use Disorder Are Associated With Higher 30-Day Readmission Rates in Patients Initially Admitted for Ulcerative Colitis

Introduction: Ulcerative colitis (UC) is a chronic disorder that predisposes patients to multiple complications. Readmissions to the hospital pose a burden to patients and health-care systems. Preventing readmissions is important for quality of care and quality of life of patients with UC. We aim to identify the incidence of 30-day readmissions and its predictors. Methods: Retrospective review of the 2018 National Readmission Database (NRD) of adult patients readmitted after an index admission of UC. ICD-10CM/PCS codes were used to identify UC, other comorbidities and procedures. We identified the most common causes for readmission and independent risk factors for readmission were identified using Cox regression analysis. Results: A total of 68,889 index admission (IA) patients were identified, out of which 16.5% (n=11,411) were readmitted within 30-days of discharge. 8.3% of readmissions were secondary to sepsis. Readmitted patients had higher rates of in-hospital mortality (3.4% vs. 2.1%; P< 0.01). Readmitted patients were less likely to be female (50.5% vs 52.8%; P< 0.01), to have private insurance (34.4% vs 40.3%; P< 0.01), to undergo colonoscopy (10.8% vs 17.7%; P< 0.01) and to be from the highest quartile of income (21.9% vs 23.3%; P=0.01). They were more likely to be older (54.0 vs 53.2 years; P< 0.01), to have a Charlson Comorbidity Index (CCI) score of ≥3 (34.1 vs 24.1; P< 0.01), to be from large metropolitan areas with at least 1 million residents (61.1 vs 59.9; P< 0.01), to require parenteral nutrition (3.2% vs 1.5%; P< 0.01), to be malnourished (20.3% vs 11.8%; P< 0.01), to have concomitant Clostridium difficile (6.9% vs. 5.7%; P< 0.01), primary sclerosing cholangitis (0.5% vs 0.2%; P< 0.01) and opioid use disorder (OUD) (3.5% vs 2.4%; P< 0.01). Independent predictors of readmission were CCI of ≥ 3 (aHR 1.95; 95% CI [1.78- 2.13]), undergoing ileostomy during IA (aHR 1.39; 95% CI [1.06-1.82]), increasing LOS (aHR 1.00; 95% CI [1.00-1.01), malnutrition (aHR 1.29; 95% CI [1.17-1.43]) and OUD (aHR 1.45; 95% CI [1.26-1.68]). Private insurance (aHR 0.78; 95% CI [0.72-0.85]), female gender (aHR 0.92; 95% CI [0.87-0.98]) and younger age (aHR 0.99; 95% CI [0.99-0.99]) were associated with less odds of early readmission. (Figure) (Table) Conclusion: The 30-day readmission rate for UC in 2018 was 16.5%. Readmission is associated with higher mortality and are associated with risk factors such as malnutrition and OUD. Early readmissions in UC continues to pose a high burden to patients and our health-care system.Figure 1.: Kaplan Meier graph of 30-day readmission Table 1. - Independent Predictors of 30-day readmission Variable Adjusted odds ratio (95% confidence interval) P value Female 0.92 (0.87-0.98) < 0.01 Age 0.99 (0.99-0.99) < 0.01 Length of stay 1.00 (1.00-1.01) < 0.01 Insurance Provider Medicare Reference Reference Medicaid 0.96 (0.87-1.06) 0.48 Private 0.78 (0.72-0.85) < 0.01 Uninsured 0.81 (0.69-0.96) 0.01 Charlson Comorbidity Index Score 0 1 Reference Reference 2 1.12 (1.03-1.22) < 0.01 ≥3 1.37 (1.24-1.51) < 0.01 Patient residence Large metropolitan area with at least 1 million residents Reference Reference Small metropolitan areas with less than 1 million residents 0.98 (0.92-1.05) 0.75 Micropolitan areas 0.94 (0.79-1.12) 0.53 Not metropolitan or micropolitan (nonurban residual) 0.75 (0.55-1.04) 0.08 In-Hospital Procedures Partial Colectomy 0.91 (0.62-1.32) 0.63 Total colectomy 0.92 (0.70-1.22) 0.58 Ileostomy 1.39 (1.06- 1.82) 0.01 Colonoscopy 1.04 (0.89-1.23) 0.57 Parenteral nutrition 1.19 (0.97-1.46) 0.09 Other Comorbidities Malnutrition 1.29 (1.17-1.43) < 0.01 Obesity 1.00 (0.92-1.08) 0.95 PSC 1.44 (0.98-2.11) 0.06 Alcohol use disorder 1.05 (0.92-1.19) 0.42 Opioid use disorder 1.45 (1.26-1.68) < 0.01 Cannabis use disorder 0.87 (0.72-1.06) 0.18 Diabetes type 1 1.49 (0.98-2.26) 0.06 Diabetes type 2 1.01 (0.93-1.09) 0.74 Shock 1.09 (0.87-1.38) 0.41 Teaching bed size Small Reference Medium 0.96 (0.87-1.06) 0.45 Large 1.06 (0.97-1.15) 0.16

Real-world outcomes of telehealth initiative to reduce readmissions for patients with cancer.

387 Background: Unplanned readmissions in patients with cancer increase both financial toxicity and mortality. It adversely impacts their quality of life by increasing distress for the patient and caregivers. Improving the transition from inpatient to outpatient care has shown to reduce readmissions. The goal of our study is to reduce hospital readmission rate for patients with solid malignancies by implementing a Telehealth transitional care visit for patients with a high EPIC readmission score at the time of discharge. Methods: A pilot study of patients with thoracic and gastrointestinal malignancies who had a high (≥23%) EPIC readmission score at discharge home between March 2021 and May 2022 were included. Patients who were discharged to a skilled nursing facility/rehabilitation center and patients who were admitted for scheduled chemotherapy were excluded. Telehealth visit with an Advanced Practice Provider (APP) was scheduled within seven days after discharge. It included evaluation of medications, addressing reasons for the index admission, review of symptoms, concerns and reminders for follow up appointments with the primary oncologist team. Readmission rates were compared to a control cohort. Results: A total of 44 patients with high readmission score underwent a Telehealth visit following discharge home. The median age was 63.5 years (range 38-83). Of the 44 patients, 36% (16) were male and 64% (28) were female. Fourteen (32%) patients had thoracic malignancy and 30 (68%) had gastrointestinal malignancy. All patients had received at least one line of chemotherapy. Twelve of the 44 patients (27.3%) had a true 30-day readmission which was lower compared to the control group (31.8%, 14/44 patients) who did not have a Telehealth intervention. Conclusions: A timely Telehealth visit within seven days of the index admission can positively impact the true 30-day readmission rate for patients with cancer.

In-hospital mortality rate and predictors of 30-day readmission in patients with iron deficiency anemia and diastolic heart failure: A cross-sectional study

Introduction: There is currently strong evidence of the adverse effects of anemia on the prognosis of heart failure with reduced ejection fraction. Unfortunately, the data on the effects of anemia on a large sample of patients with diastolic heart failure (DHF) is lacking. In this study, we aimed to evaluate the effect of iron deficiency anemia on DHF readmission rates and its corresponding causes and burdens on the healthcare system. Methods: We utilized 2018 Nationwide readmission data and included patients aged ≥18 years with ICD-10 CM code indicating acute or acute chronic diastolic heart failure and iron deficiency anemia was included in the study. The primary outcome is 30-day readmission rates. Secondary outcomes were mortality rates, common causes of readmission, and healthcare utilization. Independent predictors for readmission were identified using cox regression analysis. Results: The total number of admissions in our study was 795,777. The mean age was 74.4 years (SD=13.7), and 63.54% were females. The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia was 18.32 % vs. 16.01% in patients without anemia. The mortality rate at index admission and readmission was 3.62 % (2601) and 5.82 % (737), respectively. The most common cause of readmission was hypertensive heart and kidney disease with heart failure (17.74%). The independent predictors of readmission were age&lt;85 years, household income &lt;59000$/per year, Medicare and Medicaid insurance, higher Elixhauser comorbidities score, longer Length of stay during the index admission, discharge to a nursing home, hospital located in a large metropolitan area. The financial burden on healthcare for all the readmission was $837 million for 2018. Conclusion: The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia is 18.32% in the year 2018. The mortality rate increased from 3.62 % to 5.82 % with readmission. The financial burden for readmission during that year was $837 million. Future studies are warranted to treat iron deficiency anemia to prevent readmissions in diastolic heart failure.

Effect of selective, complete or sentinel lymphadenectomy on overall survival for women with macrometastatic squamous cell carcinoma of the vulva (357)

<b>Objectives:</b> With the results of the recent GROINSS-V II study, completion of inguinal femoral lymphadenectomy (IFLND) prior to radiation (RT) is recommended for women with macro-metastatic involvement of inguinal lymph nodes (IFLN) due to increased groin failures with RT alone. However, it is unknown if the increased failure rate could be overcome with the use of radiosensitizing chemotherapy (Chemo/RT). Therefore, the primary objective of this study was to evaluate the effect of selective, complete, or sentinel lymphadenec- tomy alone on overall survival among women with macro-metastatic (>2 mm) squamous cell carcinoma (SCC) of the vulva that underwent treatment with primary surgery and Chemo/RT. Secondary objectives included evaluating the effect of the surgical approach on 30-day readmission rates. <b>Methods:</b> Women with FIGO Stage III, macro-metastatic (>2mm), SCC of the vulva treated with surgery followed by Chemo/RT were identified in the National Cancer Database from 2012-2017. Patients were categorized into one of three cohorts based on surgical exposure: <i>')</i> Sentinel lymphadenectomy (SLND) only, <i>2)</i> complete IFLND +/- SLND, or <i>3)</i> selective lymph node debulking. Women who did not have lymph node assessment during the initial surgery, had >90 days between surgery and start of Chemo/RT or had neoadjuvant Chemo/ RT were excluded from the analysis. Overall survival was examined using Kaplan-Meier curves, log-rank tests, and adjusted Cox proportional hazard models. Demographic variables and re-admission rates were evaluated using Chi-square and Fisher's exact tests. <b>Results:</b> A total of 994 individuals were identified; 847 (85%) had a complete IFLND +/- SLND, 80 (8%) had SLND only, and 67 (7%) had selective lymph node debulking. The cohorts did not differ in age, race, ethnicity, insurance status, or Charleson-Deyo comorbidity score (all p>0.05). Overall survival did not differ among the three cohorts (Figure 1). At five years, 50% of the complete IFLND +/- SLND cohort, 58% of the SLND only cohort, and 58% of the selective lymph node debulking cohort were alive (p=0.22). After adjusting for demographic and tumor factors, including age, race, ethnicity, insurance, Charleson-Deyo comorbidity score, tumor grade, and lymphovascular space invasion [ELB1], there was no difference in the risk of death when comparing SLND only (aHR: 0.72; 95% CI: 0.46-1.13) or selective lymph node debulking (aHR: 0.98; 95% CI: 0.61-1.58) to complete IFLND +/- SLND. However, complete IFLND +/- SLND was associated with a non-significant, higher rate of 30-day readmissions with 3.7% compared to 2.5% and 1.5% for SLND only and selective lymph node debulking, respectively (p=0.70). Fig. 1 <b>Conclusions:</b> For women with macro-metastatic SCC of the vulva, there was no difference in overall survival for selective, complete, or sentinel lymphadenectomy when patients were treated with adjuvant Chemo/RT. However, there was a non-significant trend of higher 30-day re-admission rates for patients undergoing complete IFLND +/- SLND. Further randomized trials are needed to validate the safety of forgoing complete IFLND in patients with macro-metastatic SCC of the vulva, who undergo either SLND or selective IFLND debulking followed by adjuvant Chemo/RT.