Burden Of Readmissions Research Articles

Readmission and mortality during the first year after an acute stroke: A prospective cohort study from Cameroon.

Hospital readmission after discharge for stroke is associated with high morbidity and mortality. There is a paucity of data on the burden of stroke readmission in most sub-Saharan African countries. We aimed to determine the rate, reasons and predictors of hospital readmission and the mortality rate within 12 months of discharge among stroke survivors in Cameroon. This prospective cohort included patients who survived hospitalization for an acute stroke and who were discharged from two referral hospitals in the capital city of Cameroon between January 2013 and December 2013.We performed logistic regression analysis to identify demographic and clinical factors associated with readmission within 1 year of discharge and causes of readmission. Of the 254 consecutive patients admitted for acute stroke, 198 were discharged alive. There were 107 (54%) males, and their mean age (SD) was 61.7 (13.9) years (range: 10 to 95 years). A total of 30 (15.2%) patients were readmitted following discharge from the index admission over a mean follow-up time of 286.9 (127.6) days. Of these, 14 (46.7%) were discharged and 16 (53.3%) died after readmission. Thirty percent (30%) of readmissions occurred within the first month. The most frequent causes of readmissions were infections (30%) and recurrent stroke (26.7%). Factors associated with readmission in bivariate analysis were initial admission temperature > 37.5°C (risk ratio [RR]: 1.3, p = 0.021) and initial admission Glasgow Coma Score < 14 (RR: p = 1.23, p = 0.019). After stratified adjustment for age and sex, temperature > 37.5°C (adjusted RR: 1.3, 95% CI: 1-1.7, p = 0.036) and GCS <14 (adjusted RR: 1.23, 95% CI: 1-1.6, p = 0.041) were associated with readmission. Readmission after discharge for stroke was common with nearly one third occurring within the first month and more than half dying following readmission. The most common causes of readmission were infections and recurrent stroke.

The burden of readmissions after rib fractures among older adults

BackgroundThe index hospitalization morbidity and mortality of rib fractures among older adults (aged ≥65 years) is well-known, yet the burden and risks for readmissions after rib fractures in this vulnerable population remain understudied. We aimed to characterize the burdens and etiologies associated with 3-month readmissions among older adults who suffer rib fractures. We hypothesized that readmissions would be common and associated with modifiable etiologies. MethodsThis survey-weighted retrospective study using the 2017 and 2019 National Readmissions Database evaluated adults aged ≥65 years hospitalized with multiple rib fractures and without major extrathoracic injuries. The main outcome was the proportion of patients experiencing all-cause 3-month readmissions. We assessed the 5 leading principal readmission diagnoses overall and delineated them by index hospitalization discharge disposition (home or facility). Sensitivity analysis using clinical classification categories characterized readmissions that could reasonably represent rib fracture-related sequelae. ResultsIn 2017, 25,092 patients met the inclusion criteria, with 20% (N = 4,894) experiencing 3-month readmissions. Six percent of patients did not survive their readmission. The 5 leading principal readmission diagnoses were sepsis (many associated with secondary diagnoses of pneumonia [41%] or urinary tract infections [41%]), hypertensive heart/kidney disease, hemothorax, pneumonia, and respiratory failure. In 2019, a comparable 3-month readmission rate of 23% and identical 5 leading diagnoses were found. Principal readmission diagnosis of hemothorax was associated with the shortest time to readmission (median [interquartile range]:9 [5–23] days). Among patients discharged home after index hospitalization, pleural effusion–possibly representing mischaracterized hemothorax–was among the leading principal readmission diagnoses. Some patients readmitted with a principal diagnosis of hemothorax or pleural effusion had these diagnoses at index hospitalization; a lower proportion of these patients underwent pleural fluid intervention during index hospitalization compared with readmission. On sensitivity analysis, 30% of 3-month readmissions were associated with principal diagnoses suggesting rib fracture-related sequelae. ConclusionReadmissions are not infrequent among older adults who suffer rib fractures, even in the absence of major extrathoracic injuries. Future studies should better characterize how specific complications associated with readmissions, such as pneumonia, urinary tract infections, and delayed hemothoraces, could be mitigated.

Emergency general surgery in older adult patients: Factors associated with fragmented care

BackgroundCare fragmentation has been shown to lead to increased morbidity and mortality. We aimed to explore the factors related to care fragmentation after hospital discharge in geriatric emergency general surgery patients, as well as examine the association between care fragmentation and mortality. MethodsWe designed a retrospective study of the Nationwide Readmissions Database 2019. We included patients ≥65 years old admitted with an emergency general surgery diagnosis who were discharged alive from the index admission. The primary outcome was 90-day care fragmentation, defined as an unplanned readmission to a non-index hospital. Multivariable logistic regression was performed, adjusting for patient and hospital characteristics. ResultsA total of 447,027 older adult emergency general surgery patients were included; the main diagnostic category was colorectal (22.6%), and 78.2% of patients underwent non-operative management during the index hospitalization. By 90 days post-discharge, 189,622 (24.3%) patients had an unplanned readmission. Of those readmitted, 20.8% had care fragmentation. The median age of patients with care fragmentation was 76 years, and 53.2% were of female sex. Predictors of care fragmentation were living in rural counties (odds ratio 1.76, 95% confidence interval: 1.57–1.97), living in a low-income ZIP Code, discharge to intermediate care facility (odds ratio 1.28, 95% confidence interval: 1.22–1.33), initial non-operative management (odds ratio 1.17, 95% confidence interval: 1.12–1.23), leaving against medical advice (odds ratio 2.60, 95% confidence interval: 2.29–2.96), and discharge from private investor-owned hospitals (odds ratio 1.18, 95% confidence interval: 1.10–1.27). Care fragmentation was significantly associated with higher mortality. ConclusionThe burden of unplanned readmissions in older adult patients who survive an emergency general surgery admission is underestimated, and these patients frequently experience care fragmentation. Future directions should prioritize evaluating the impact of initiatives aimed at alleviating the incidence and complications of care fragmentation in geriatric emergency general surgery patients.

Improving patient education in hospitalized patients with chronic obstructive pulmonary disease: A quality improvement initiative using LEAN methodology.

Chronic obstructive pulmonary disease (COPD) is a costly chronic disease affecting more than 15 million Americans. The prevalence among US veterans is 3 times higher than the general population. The Veteran Health Administration developed a standardized, evidence-based COPD educational tool called Green Light to Go (GLTG) designed to educate patients on managing their COPD symptoms at home. Despite the availability of this resource, inpatient education on COPD self-management practices is highly variable across different medical teams. This quality improvement (QI) initiative sought to standardize inpatient COPD patient education using the GLTG tool. This initiative also assessed whether patients receiving standardized patient education during their index hospitalization had lower COPD 30-day readmission rates. The QI initiative followed the LEAN methodology and the A3 framework. The team performed rapid tests of change (plan-do-study-act cycles) to increase the percentage of veterans receiving COPD education. The interventions implemented for this QI initiative focused on clinical, patient, and system improvements. This initiative standardized COPD patient education and increased the percentage of veterans receiving (a) daily COPD education from 0% to 66%, (b) verbal COPD education on discharge from a baseline of 20% to 100%, (c) receipt of written educational material on discharge from 20% to 100%, and (d) the cohort all-cause 30-day readmission rate declined from 19.3% to 14.3%. Given the substantial economic burden of COPD readmissions on the health care system and patients, evidence-based educational interventions may potentially improve outcomes and reduce hospital readmissions in this veteran population.

The burden and predictors of 30-day unplanned readmission in patients with acute liver failure: a national representative database study

BackgroundLiver diseases were significant source of early readmission burden. This study aimed to evaluate the 30-day unplanned readmission rates, causes of readmissions, readmission costs, and predictors of readmission in patients with acute liver failure (ALF).MethodsPatients admitted for ALF from 2019 National Readmission Database were enrolled. Weighted multivariable logistic regression models were applied and based on Directed Acyclic Graphs. Incidence, causes, cost, and predictors of 30-day unplanned readmissions were identified.ResultsA total of 3,281 patients with ALF were enrolled, of whom 600 (18.3%) were readmitted within 30 days. The mean time from discharge to early readmission was 12.6 days. The average hospital cost and charge of readmission were $19,629 and $86,228, respectively. The readmissions were mainly due to liver-related events (26.6%), followed by infection (20.9%). The predictive factors independently associated with readmissions were age, male sex (OR 1.227, 95% CI 1.023–1.472; P = 0.028), renal failure (OR 1.401, 95% CI 1.139–1.723; P = 0.001), diabetes with chronic complications (OR 1.327, 95% CI 1.053–1.672; P = 0.017), complicated hypertension (OR 1.436, 95% CI 1.111–1.857; P = 0.006), peritoneal drainage (OR 1.600, 95% CI 1.092–2.345; P = 0.016), etc.ConclusionsPatients with ALF are at relatively high risk of early readmission, which imposes a heavy medical and economic burden on society. We need to increase the emphasis placed on early readmission of patients with ALF and establish clinical strategies for their management.

Machine learning-based prediction of coronary care unit readmission: A multihospital validation study.

Readmission to the coronary care unit (CCU) has significant implications for patient outcomes and healthcare expenditure, emphasizing the urgency to accurately identify patients at high readmission risk. This study aims to construct and externally validate a predictive model for CCU readmission using machine learning (ML) algorithms across multiple hospitals. Patient information, including demographics, medical history, and laboratory test results were collected from electronic health record system and contributed to a total of 40 features. Five ML models: logistic regression, random forest, support vector machine, gradient boosting, and multilayer perceptron were employed to estimate the readmission risk. The gradient boosting model was selected demonstrated superior performance with an area under the receiver operating characteristic curve (AUC) of 0.887 in the internal validation set. Further external validation in hold-out test set and three other medical centers upheld the model's robustness with consistent high AUCs, ranging from 0.852 to 0.879. The results endorse the integration of ML algorithms in healthcare to enhance patient risk stratification, potentially optimizing clinical interventions, and diminishing the burden of CCU readmissions.

IMPLEMENTING AND TESTING THE EFFICACY OF A GERIATRIC GOALS OF CARE TOOL IN AN ACUTE HOSPITAL SETTING

Abstract Goals of care (GOC) discussions, which focus on patient values and preferences, are associated with improved outcomes for older adults, including lower hospital readmission rates, increased adherence to advanced care plans, and improved patient satisfaction. GOC discussions do not occur consistently and a reliable method of documentation has yet to be established. The Geriatrics Goals of Care (GGOC) tool was developed to easily review and document GOC discussions for geriatric patients (65 years and older) in the electronic medical record, focusing on pre-hospital function and hospitalization goals. The study objective was to evaluate the GGOC tool’s impact on 30-day hospital readmission. Using an experimental design, the GGOC tool was implemented in one hospital unit and a second comparative unit served as a control. The GGOC tool was administered to a total of 82 patients and 162 control unit patients received standard care (N= 244). A logistic regression of patient-level data revealed that the odds of having a hospital readmission within 30 days were approximately 65% lower for patients who received the GGOC tool compared to those in the control unit (OR = .344, SE = .40, p = .008, 95% CI [.156, .759]). The readmission rate for the unit utilizing the GGOC tool yielded a cost savings of $185,019.12. Applying the same readmission rate to the control unit, the expected cost savings was $365,625 for the control group. Results suggest that the GGOC tool may be effective for documenting GOC discussions, reducing the burden of readmissions with their associated costs.

The Impact of Inadequate Energy Intake on Readmission Burden of Patients With Heart Failure.

Adequate energy intake is essential for good clinical outcomes. The association between energy intake and readmission burden of patients with heart failure (HF) still needs to be clarified. In this study, our aim was to determine the association between energy intake and readmission in patients with HF. A total of 311 inpatients with HF were recruited. Demographic and clinical information were collected during hospitalization; the daily diets of the participants were collected in the second week after discharge using the 3-day diet record, and the energy intake was calculated using a standardized nutrition calculator. The inadequate energy intake was defined as <70% × 25 kcal/kg of ideal body weight. The participants were followed up for 12 weeks after discharge. The number, reasons, and length of stay of unplanned readmissions were collected. Regression analyses were used to evaluate the associations between inadequate energy intake, and readmission rate and readmission days. The median of the energy intake of participants was 1032 (interquartile range, 809-1266) kcal/d. The prevalence of inadequate energy intake was 40%. Patients with inadequate energy intake had a higher risk of unplanned readmission (odds ratio, 5.616; 95% confidence interval, 3.015-10.462; P < .001) and more readmission days (incidence rate ratio, 5.226; 95% confidence interval, 3.829-7.134, P < .001) after adjusting for potential confounders. Patients with HF had a high incidence of inadequate dietary energy intake, and it increases the burden of readmission.

Understanding the Burden of 30-Day Readmission in Patients With Both Primary and Secondary Diagnoses of Heart Failure: Causes, Timing, and Impact of Co-Morbidities

Although efforts to reduce 30-day readmission rates have mainly focused on patients with heart failure (HF) as a primary diagnosis at index hospitalization, patients with HF as a secondary diagnosis remain common, costly, and understudied. This study aimed to determine the incidence, etiology, and patterns of 30-day readmissions after discharge for HF as a primary and secondary diagnosis and investigate the impact of co-morbidities on HF readmission. The National Readmission Database from 2014 to 2016 was used to identify HF patients with a linked 30-day readmission. Patient and hospital characteristics, admission features, and Elixhauser-related co-morbidities were compared between the 2 groups. Readmitted patients in both groups were younger, male, with lower household income, higher mortality risk, and higher hospitalization costs. Over 60% of readmissions were for reasons other than HF, and greater than 1/3 had more than 2 readmissions within 30 days, with a median time to readmission of 12 days. Both cohorts had high readmission rates and high rates of readmission for causes other than HF. Our findings suggest that efforts to reduce 30-day readmission rates should be extended to patients with secondary HF diagnosis, with surveillance extending to 2 weeks postdischarge to identify patients at risk.

Factors Associated with Readmission of Cardiovascular Patients: A Cross-sectional Study in Iran

Objective: Cardiovascular diseases are the main cause of death in both men and women around the world. Considering the heavy economic and social burden of readmission of cardiovascular patients on the patients and their families as well as the health care system, this study aimed at determining the factors associated with hospital readmission of cardiovascular patients in four public hospitals affiliated with Shiraz University of Medical Sciences, Iran. Methods: This cross-sectional study was conducted on cardiovascular patients hospitalized in public hospitals affiliated with Shiraz University of Medical Sciences, Iran. A total of 264 patients were studied, 132 of whom had been readmitted and were selected through the census method. The other 132 patients had not been readmitted and were randomly selected through stratified sampling proportional to the size and simple random sampling method. The patients were examined using a questionnaire developed according to previous studies and experts' opinions. To analyze the data collected, we used the t-test, chi-square, Fisher’s exact test, Mann-Whitney test, and logistic regression through the SPSS 23.0 software. Results: The results showed that the following factors were associated with the readmission of the cardiovascular patients: being hospitalized 6 to 9 months before the current admission (OR=19.03, P-value&lt;0.001), having arrhythmia (OR=6.34, P-value&lt;0.001), having right ventricular dysfunction (OR=4.99, P-value=0.019), having fluid and electrolyte disorder (OR=3.89, P-value=0&lt;0.001), undergoing angiography (OR=2.96, P-value=0.003), having chest pain (OR=2.42, P-value=0.014), having cardiovascular and non-cardiovascular co-morbidities (OR=1.45, P-value=0&lt;0.001), and having non-elective admission (OR=2.10, P-value=0.034). Conclusion: Given the influencing factors, management and follow-up of the patients, especially the high-risk ones, after discharge and providing them with the necessary training to prevent various complications could reduce their readmission rates.

Readmission Rates After Acute Respiratory Distress Syndrome in Children

An increasing number of children survive after acute respiratory distress syndrome (ARDS). The long-term morbidity affecting these survivors, including the burden of hospital readmission and key factors associated with readmission, is unknown. To determine 1-year readmission rates among survivors of pediatric ARDS and to investigate the associations of 3 key index hospitalization factors (presence or development of a complex chronic condition, receipt of a tracheostomy, and hospital length of stay [LOS]) with readmission. This retrospective cohort study used data from the commercial or Medicaid IBM MarketScan databases between 2013 and 2017, with follow-up data through 2018. Participants included hospitalized children (aged ≥28 days to <18 years) who received mechanical ventilation and had algorithm-identified ARDS. Data analysis was completed from March 2022 to March 2023. Complex chronic conditions (none, nonrespiratory, and respiratory), receipt of tracheostomy, and index hospital LOS. The primary outcome was 1-year, all-cause hospital readmission. Univariable and multivariable Cox proportional hazard models were created to test the association of key hospitalization factors with readmission. One-year readmission occurred in 3748 of 13 505 children (median [IQR] age, 4 [0-14] years; 7869 boys [58.3%]) with mechanically ventilated ARDS who survived to hospital discharge. In survival analysis, the probability of 1-year readmission was 30.0% (95% CI, 29.0%-30.8%). One-half of readmissions occurred within 61 days of discharge (95% CI, 56-67 days). Both respiratory (adjusted hazard ratio [aHR], 2.69; 95% CI, 2.42-2.98) and nonrespiratory (aHR, 1.86; 95% CI, 1.71-2.03) complex chronic conditions were associated with 1-year readmission. Placement of a new tracheostomy (aHR, 1.98; 95% CI, 1.69-2.33) and LOS 14 days or longer (aHR, 1.87; 95% CI, 1.62-2.16) were associated with readmission. After exclusion of children with chronic conditions, LOS 14 days or longer continued to be associated with readmission (aHR, 1.92; 95% CI, 1.49-2.47). In this retrospective cohort study of children with ARDS who survived to discharge, important factors associated with readmission included the presence or development of chronic medical conditions during the index admission, tracheostomy placement during index admission, and index hospitalization of 14 days or longer. Future studies should evaluate whether postdischarge interventions (eg, telephonic contact, follow-up clinics, and home health care) may help reduce the readmission burden.

Burden, Causes, and Outcomes of Hospitalization in Patients With Giant Cell Arteritis: A US National Cohort Study.

Giant cell arteritis (GCA) has a relapsing-remitting course and is associated with a high burden of comorbidities, leading to repeated hospitalizations. This study was undertaken to investigate the burden, risk factors, causes, and outcomes of hospitalization and readmission in GCA patients in a US national cohort. Using the 2017 US National Readmission Database, we identified adults ≥50 years of age hospitalized with GCA between January and June 2017, with at least 6 months of follow-up. We estimated the burden of hospitalization including 6-month risk of readmission, total days spent in hospital, and costs, annually. We examined patient-, hospital-, and index hospitalization-related factors for 6-month readmission and total days of hospitalization using binomial logistic regression. Our study included 1,206 patients hospitalized with GCA (70% women, median age 77 years), with 13% of patients experiencing GCA-related ophthalmologic complications at index hospital admission. On follow-up, 3% died, and 34% of patients were readmitted within 6 months, primarily for infections (23%) and cardiovascular diseases (CVDs) (15%). Charlson comorbidity index (CCI) of ≥1, smoking, and obesity were associated with readmission. GCA patients spent a median of 5 days/year in hospital (interquartile range [IQR] 3-11), with those in the top quartile spending 19 days/year in hospital (IQR 14-26). GCA patients frequently experience unplanned health care utilization, with 1 in 3 patients experiencing readmission within 6 months, and 3% dying within the follow-up period. Infection and CVDs are common causes of readmission and may be related to glucocorticoid exposure. Population health management strategies are required in these vulnerable GCA patients.

Racial differences in clinical characteristics and readmission burden among patients with a left ventricular-assist device.

There are limited data regarding racial disparities in outcomes after left ventricular assist device (LVAD) implantation. The purpose of this study was to compare clinical characteristics and the burden of readmissions by race among patients with LVAD. The study population included 461 patients implanted with LVADs at the University of Rochester Medical Center, NY from May 2008 to March 2020. Patients were stratified by race as White patients (N=396 [86%]) and Black patients (N=65 [14%]). The Anderson-Gill recurrent regression analysis was used to assess the independent association between race and the total number of admissions after LVAD implant during an average follow-up of 2.45 ± 2.30 years. Black patients displayed significant differences in baseline clinical characteristics compared to White patients, including a younger age, a lower frequency of ischemic etiology, and a higher baseline serum creatinine. Black patients had a significantly higher burden of readmissions after LVAD implantation as compared with White patients 10 versus 7 (average number of hospitalizations per patient at 5 years of follow-up, respectively) translated into a significant 39% increased risk of recurrent readmissions after multivariate adjustment (Hazard ratio 1.39, 95% CI; 1.07-1.82, p 0.013). Black LVAD patients experience an increased burden of readmissions compared with White patients, after adjustment for baseline differences in demographics and clinical characteristics. Future studies should assess the underlying mechanisms for this increased risk including the effect of social determinants of health on the risk of readmissions in LVAD recipients.

Incidence, Burden, and Predictors of Readmission for Acute Alcoholic Pancreatitis: A National Analysis over 11Months.

Data regarding incidence, health-care burden, and predictors for readmission in patients with acute alcoholic pancreatitis (AAP) is scarce. We aim to identify incidence, health-care burden, and predictors of readmission over an 11-month period. Retrospective cohort study using the 2016 National Readmission Database of adult patients admitted with a principal diagnosis of AAP in January and 11-month readmission follow up for all-cause readmission. Incidence of all-cause readmission, mortality rate, morbidity, length of stay (LOS), total hospitalization charges and costs were evaluated. Independent risk factors for all-cause readmission were identified using a Cox multivariate logistic regression analysis. A total of 6633 patients were included in the study. The mean age was 45.7years and 28.9% of patients were female. 73.1% of patients had a modified BISAP score of 0. The 11-month readmission rate was 43.1%. The main cause of readmission was another episode of AAP. The mortality rate of readmission was 0.5% and the mortality rate during the index admission (IA) was 1.1% (P = 0.03). The mean LOS, total hospitalization charges and costs for readmission were 4.5days, $34,307 and $8958, respectively. Independent predictors of readmission were Charlson Comorbidity Index score of ≥ 3, associated chronic alcoholic pancreatitis, and chronic pancreatitis (CP) from other causes. Among patients admitted with AAP, the 11-month readmission rate was 43.1%. Over one-third of readmissions were due to another episode of AAP. Readmission associated with significant resource utilization. Special attention should be placed in patients with underlying CP due to the increased risk of readmission.

Incidence, Burden, and Predictors of 11-Month Readmission in Patients Undergoing Bariatric Surgery.

Bariatric surgery (BSx) is one of the most common surgical procedures performed in the USA. Nonetheless, data regarding 11-month period after BSx remain limited. A retrospective cohort study using the 2016 National Readmission Database. Adult patients admitted for BSx in January were included. The follow-up period was 11months (February-December). The primary outcome was all-cause 11-month readmission. Secondary outcomes were index admission (IA) and readmission in-hospital mortality rate and healthcare resource use associated with readmission. Multivariate regression was performed to identify independent risk factors for readmission. A total of 13,278 IA were included. The 11-month readmission rate was 11.1%. The mortality rate of readmission was 1.4% and 0.1% for IA (P < 0.01). The most common cause of readmission was hematemesis. Independent predictors were Charlson comorbidity index (CCI) score ≥ 3 (adjusted hazard ratio [aHR] 1.34; P = 0.05), increasing length of stay (aHR 1.01; P < 0.01), transfer to rehabilitation facilities (aHR 5.02; P < 0.01), undergoing laparoscopic Roux-en-Y gastric bypass (aHR 1.71; P = 0.02), adjustable gastric band (aHR 14.09; P < 0.01), alcohol use disorder (2.10; P = 0.01), and cannabis use disorder (aHR 3.37; P = 0.01). Private insurance as primary payer (aHR 0.65; P < 0.01) and BMI 45-49kg/m2 (aHR 0.72; P < 0.01) were associated with less odds of readmission. The cumulative total hospitalization charges of readmission were $69.9 million. The 11-month readmission rate after BSx is 11.1%. Targeting modifiable predictors of readmission may help reduce the burden of readmissions on our healthcare system.

S1341 Burden and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations

S1341 Burden and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations

Rates, Reasons, and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations in the USA.

Portal vein thrombosis (PVT), generally considered rare, is becoming increasingly recognized with advanced imaging. Limited data exist regarding readmissions in PVT and its burden on the overall healthcare cost. This study aimed to outline the burden of PVT readmissions and identify the modifiable predictors of readmissions. The National Readmission Database (NRD) was used to identify PVT admissions from 2016 to 2019. Using the patient demographic and hospital-specific variables within the NRD, we grouped patient encounters into two cohorts, 30- and 90-day readmission cohorts. We assessed comorbidities using the validated Elixhauser comorbidity index. We obtained inpatient mortality rates, mean length of hospital stay (LOS), total hospital cost (THC), and causes of readmissions in both 30- and 90-day readmission cohorts. Using a multivariate Cox regression analysis, we identified the independent predictors of 30-day readmissions. We identified 17,971 unique index hospitalizations, of which 2,971 (16.5%) were readmitted within 30 days. The top five causes of readmissions in both 30-day and 90-day readmission cohorts were PVT, sepsis, hepatocellular cancer, liver failure, and alcoholic liver cirrhosis. The following independent predictors of 30-day readmission were identified: discharge against medical advice (AMA) (adjusted hazard ratio (aHR) 1.86; P = 0.002); renal failure (aHR 1.44, P = 0.014), metastatic cancer (aHR 1.31, P = 0.016), fluid and electrolyte disorders (aHR 1.20, P = 0.004), diabetes mellitus (aHR 1.31, P = 0.001) and alcohol abuse (aHR 1.31, P ≤ 0.001). The readmission rate identified in this study was higher than the national average and targeted interventions addressing these factors may help reduce the overall health care costs.

S575 Rate and Reasons for Non-Elective 30-Day Readmissions for Functional Dyspepsia in the U.S.

Introduction: Functional dyspepsia (FD), a diagnosis of exclusion, has a 10–20% prevalence(1,2). The pathophysiology is unclear, often multifactorial, and involves treatment with a detailed education about its benign nature. Tricyclic antidepressants and psychotherapy are warranted if functional dyspepsia (FD) is refractory or severe (1). Functional dyspepsia (FD) can present with postprandial distress (70% of FD cases) or epigastric pain syndrome (30% of FD cases) (3). FD can decrease quality of life and place a significant cost burden on healthcare services. Our study sought to determine the rate and reasons for 30-day all-cause readmissions for FD to help identify potentially modifiable factors and decrease the burden of readmissions. Methods: From the NRD, we identified all adults discharged with a principal diagnosis of FD after hospitalization from 2016 to 2019. Then, we identified any readmission of the same patient within 30-days for FD, excluding elective and traumatic encounters. Outcomes assessed included 30-day all-cause readmissions, top principal diagnosis for the readmitted patients, comparison of mortality, length of stay (LOS), and total hospital charges (THC) following readmission. Results: 4 917 patients with FD during index admissions were identified. The 30-day all-cause readmission rate was 19.3%. The Kaplan-Meier curve for 30-day all-cause readmissions was split by sex (Figure). There was no significant difference in age and sex distribution between patients with initial hospitalizations and those with readmissions. The most common reasons for readmissions in patients with FD were gastroparesis (5.9%), FD (5.8%), sepsis unspecified (5.2%), unspecified nausea and vomiting (3.1%), unspecified abdominal pain (2.1%), and acute renal failure (2.0%). Readmission was associated with higher odds of mortality (2.8% vs. < 0.01%, p< 0.001), longer LOS (6.0 vs. 5.0 days, p< 0.001), and higher THC. Over the period, readmissions for FD accounted for a cumulative 5.694 days of hospitalization, costing over $14 million. Conclusion: 1 in 4 patients was readmitted with FD within 30 days. Gastroparesis contributed more to readmissions than a primary diagnosis of FD. Higher rates of poorer outcomes were found with 30-days readmissions. Cohort studies are needed to validate these results.Figure 1.: Survival estimates for 30-day all-cause readmissions in male and Female patients with functional dyspepsia

Adverse Events With Esophageal Stenting: A Call to Optimize Device and Endoscopic Placement

Background and AimsDespite technological and procedural improvements, esophageal stents (ESs) have high rates of adverse events (AEs), including stent migration, recurrent stenosis, and chest pain. We sought to evaluate predictors and causes for early readmission following ES placement in hospitalized patients. MethodsThe National Readmission Database 2016-2018 was queried to identify hospitalized patients with an ICD-10-CM code for endoscopic ES placement. Primary outcome was early (≤ 30-day) readmission rate. Univariate and multivariable logistic regression models were used to evaluate predictors of early readmission. ResultsA total of 949 patients underwent index ES placement, and most (67%, n = 634) patients had benign indications. Overall, the most common indication was benign esophageal leak/fistula (n = 359), followed by malignant dysphagia from esophageal neoplasm (n = 252). The 30-day readmission rate was 26% (n = 251), with higher rates for benign (29%) compared with malignant (22%) indications (P = 0.09). An analysis of primary diagnosis for early readmissions revealed that stent-related AEs were higher in the benign than in the malignant group (42% vs 23%, respectively; P = 0.008). Multivariable analysis revealed that ES placement for esophageal leak/fistulas (OR = 1.98; 95% CI, 1.20-3.24; P = 0.022) was the only significant variable associated with early readmission. ConclusionIn recent years, inpatient ESs have been placed predominantly in patients with benign conditions, with esophageal leak/fistula being the most common indication. Stent-related AEs account for a significant burden of readmissions, particularly when placed for benign conditions. There is a need for focused research to refine indications, optimize techniques, and improve stent technology.

Economic burden of complications and readmission following oesophageal cancer surgery.

Oesophageal cancer is the seventh most prevalent malignancy globally, and the sixth most common cause of cancer-related death. Oesophageal cancer is also one of the most costly cancers to treat. The aim of this study was to assess the financial impact of post-operative morbidity and hospital readmissions following oesophagectomy for oesophageal cancer. A retrospective analysis was performed on a prospectively maintained database of patients with oesophageal cancer who underwent an oesophagectomy at a single centre between July 2014 and June 2019 (N= 56). Readmission costs were also assessed in this cohort for 12 months post-operatively. The total median cost for oesophagectomy in this cohort was AU$57 250. Major complications occurred in 40% of patients, with a median total admission cost of AU$74 606, significantly higher than patients with either minor or no complications (median admission cost of AU$52 713, P< 0.001). Patients whose operation was complicated by an anastomotic leak had a higher median admission cost than those without a leak (AU$104 328 and AU$54 972 respectively, P< 0.001). Cost centres representing the greatest proportion of costs were theatre resources and surgical ward care (medical and nursing). A total of 110 readmissions in 25 patients were recorded in the 12 months post-operatively, the majority for gastroscopy and dilatation of anastomotic stricture. Post-oesophagectomy morbidity greatly increases cost of care. In addition to the clinical benefits, interventions to minimize post-operative complications are likely to result in substantial cost savings.