Burden Of Readmissions Research Articles

1025-P: Rate, Reasons, and Predictors of 30-Day Readmissions among Patients with Type 2 Diabetes Admitted for Hyperglycemic Hyperosmolar State: A Nationwide Analysis

Introduction: Hyperglycemic hyperosmolar state is an endocrinological emergency associated with type 2 diabetes (T2DM) patients. HHS is associated with significant morbidity and mortality. The burden of HHS, however, does not end with the index admission. This study sought to determine the rate, reasons and predictors of 30-day readmissions (30DR) in T2DM patients with index admission for HHS with the goal of identifying potentially modifiable factors to decrease the burden of readmissions. Methods: The US Readmission database for 2018 was searched for index hospitalizations involving adult patients with T2DM who had HHS in 2018. Outcomes assessed included 30DR rates, top principal diagnosis for readmitted patients, comparison of mortality, length of stay (LOS), and hospitalization costs (THC), and predictors of 30DR. Results: A total of 21,721 hospitalizations involved adults with T2DM with HHS during the index admissions. The 30DR rate was 13.77%. The most common reasons for readmission was DM type 2 with hyperglycemia (8.6%), DKA (8.1%), HHS (8.0%), sepsis unspecified (7.9%), and acute renal failure (4.2%). Readmission was associated with higher odds of mortality (2.55% vs. 0.65%, OR: 4.00, 95% CI: 2.63 - 6.07), longer LOS (5.8 vs. 3.9 days, p<0.001), higher THC (12,700 vs. 8,300 USD, p<0.001). In T2DM patients with HHS, readmissions accounted for a cumulative 17,189 days of hospitalization, costing over $38 million within the study period. Discharges against medical advice, protein energy malnutrition, COPD and overall higher Charlson Comorbidity index was associated with higher odds for readmission. Conclusion: HHS is associated with significant complications following the index admission. 30DR is associated with increased mortality and healthcare utilization in this population. Proper discharge planning and addressing factors associated with readmissions would likely improve outcome in this population. Disclosure H. Shaka: None. M. C. Aguilera: None. S. T. Yap: None. M. Ramirez: None. C. D. Corpuz: None. E. Edigin: None. P. E. Ojemolon: None. I. R. Asemota: None. E. Akuna: None.

Home Health Care Utilization Trend, Predictors, and Association With Early Rehospitalization Following Endovascular Transcatheter Aortic Valve Replacement

Background/purposeHome healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR). Methods/materialsWe queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes. ResultsOf 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29–1.40), non-elective admission (OR, 1.49; 95% CI, 1.42–1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05–1.13), prior stroke (OR, 1.06; 95% CI, 1.01–1.12), anemia (OR, 1.16; 95% CI, 1.11–1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16–1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00–1.50), stroke (OR, 2.62; 95% CI, 2.20–3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41–1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC. ConclusionsOur study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.

Risk factors for 30-day readmissions in patients with tumor lysis syndrome and solid malignancies: Analysis from the National Readmission Database.

e18863 Background: Tumor lysis syndrome (TLS) is a well-known potentially fatal complication of chemotherapy and an oncologic emergency. It is most prevalent in hematologic malignancies, but there are case reports and clinical series of occurrence after the treatment of solid tumors. Hospital readmissions are indicators of quality of care and cost control. We aim to look at the prevalence of readmissions after an initial episode of TLS in patients with solid malignancies and their financial burden on the United States healthcare system. Methods: We conducted a retrospective analysis of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an initial “index” admission of TLS (ICD10 code E88.3) with a concomitant diagnosis of solid malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent predictors of readmission by performing a COX regression analysis. Results: A total of 874 patients with solid tumors were admitted with TLS in 2017. The 30-day readmission rate was 20.4%. The main causes for readmission were sepsis, recurrent malignant lesions, metastasis to CNS, bleeding, acute kidney failure (AKI). Compared to initial admissions, readmitted patients were less likely to have acute kidney failure (AKI) (64.6% vs 30.8%; P &lt; 0.01), less likely to require mechanical ventilation (17.9% vs 5.7%; P &lt; 0.01), less likely to suffer shock (7.3% vs 2.3%; P = 0.03) and ileus (4.8% vs 0.7%; P = 0.04). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P &lt; 0.01), more likely to have private insurance (29.9% vs 36.1%; P &lt; 0.01), and more likely to be discharged home (26.2% vs 36.8%; P &lt; 0.01). The total health care in-hospital economic burden of readmission was $14.9 million in total charges to patients and $4 million in total costs for hospitals. Independent predictors of readmission were prolonged length of stay (during index admission), tobacco abuse, VTE, thrombocytopenia, and admission to an urban hospital. We identified the following preventive factors for readmission: radiation therapy, admission to a smaller hospital, total parenteral nutrition during the index admission and a primary gynecologic malignancy. Conclusions: Readmissions after TLS in patients with solid malignancy are associated with a higher in-hospital mortality rate and pose an increased health care burden. We identified risk factors that, if targeted, could lead to reducing readmissions, health care burden, and patient morbidity.

30-day readmission after TAVR (Transcatheter Aortic Valve Replacement (TAVR) in patients with malignancy.

e18620 Background: Hospital readmissions after cardiac procedures are increasingly the major focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with readmissions after transcatheter aortic valve replacement (TAVR) in patients with malignancy. Methods: We performed a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for TAVR with a concomitant diagnosis of malignancy. We aimed to identify 30-day readmission rate, mortality, healthcare related utilization of resources and other independent predictors of readmission. Results: A total of 2,213 patients with malignancy underwent TAVR. The 30-days readmission rate was 16% (n=355). Main causes of readmissions were found to be heart failure, sepsis, acute hypercapnic respiratory failure, coronary artery disease with angina, and AKI with ATN. Readmitted patients were more likely to come from small metropolitan areas (43.1% vs 33.6, p≤0.01), micropolitan areas (1.4% vs 0.35%, p≤0.01), rural hospital (20.3% vs 8.8%, p≤0.01), non-teaching hospital (23.5% vs 9.1%, p≤0.01), and small sized hospitals (11.5% vs 4%, p≤0.01). Patients re-admitted were more likely to have malnutrition (8% vs 3.2%, p≤0.01), new VTEs (3.8% vs 0.6, p≤0.01), AKI (26% vs 13.6%, p≤0.01) and deaths (4.6% vs 1.7%, p≤0.01). The total health care in-hospital economic burden of readmission was $5.9 million in total charges and $25 million in total costs. Independent predictors of readmission were disposition to short-term skilled nursing facilities, home-health care, and sepsis. Conclusions: We concluded that readmissions after TAVR in patients with malignancy are associated with higher in-hospital mortality rate and pose a higher health care burden. We also identified risk factors that can be targeted to decrease readmissions after TAVR, health care burden, and patient mortality.[Table: see text]

Thirty day readmissions and outcomes following radical nephrectomy in renal cell carcinoma: A nationwide analysis.

e16560 Background: Nephrectomy is one of the primary treatments of Stage I-III renal cell carcinoma (RCC), which is usually associated with low rates of serious morbidity and mortality. However, a fraction of patients gets readmitted after the surgery for numerous reasons which can impact their overall prognosis. Methods: We conducted a retrospective cohort study using the 2017 National Readmission Database of adult patients with RCC readmitted within 30 days after an index admission for nephrectomy. We aimed to identify the 30-day readmission rate, mortality, resource utilization, and independent predictors of readmission. Results: A total of 25,307 patients with RCC underwent nephrectomy. The 30-day readmission rate was 8.7%. The top five causes for readmission were sepsis, AKI, STEMI, surgical infections &amp; metastatic disease. Patients requiring readmission were less likely to be discharged home (56.5 vs 81.8%), have private insurance (27.2 vs 34.7), obesity (14.7 vs 20.6%), hypertension (30.9 vs 47.1%), and be admitted to a teaching hospital (75.8 vs 79.2%). They were more likely to be insured with Medicare (58.3 vs 53.3%), have lower income (28.7 vs 26.3%), type 2 diabetes (32.4 vs 26.7%), CKD (44.1 vs 20.7%), malnutrition (9.2 vs 2.1%), undergo chemotherapy (5.2 vs 1.9%). Readmission was associated with higher in-hospital mortality (1.5 vs. 0.1%), CVA (0.6 vs 0.3%), AKI (29.6 vs 16.9%) and pleural effusion (7.8 vs 1.8%). They were also more likely to require mechanical ventilation (3.5 vs 1.8%), parenteral nutrition (1.2 vs 0.4%) and hemodialysis (11.9 vs 4.5%). The in-hospital economic burden of readmission was $128 million in total charges and $31.8 million in total costs. Independent predictors of readmission were disposition to a short-term hospital or skilled nursing facility, length of stay, need for mechanical ventilation and transfusion of blood products, having type 1 diabetes, malnutrition, pleural effusion, and CKD. Younger age and private insurance were associated with preventing readmission. Conclusions: Readmissions after nephrectomy in patients with RCC are associated with increased in-hospital mortality rate and pose a high health care economic burden. We identified few risk factors and patient characteristics associated with post-surgical readmissions; however, further in-depth studies are needed to find preventable risk factors.[Table: see text]

Predictors of 30-day readmission rate after total gastrectomy in patients with gastric malignancy.

e16109 Background: Total gastrectomy with lymph node dissection is curative for early gastric malignancy which accounts for 1.5% of cancer cases in the U.S. Readmissions are common postoperatively, and are associated with increased morbidity, mortality, hospital costs and decreased quality of life. We hence aim to identify incidence, impact and independent predictors for readmission in patients who underwent total gastrectomy in gastric malignancy. Methods: We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for total gastrectomy with a concomitant diagnosis of gastric malignancy. T-test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. ICD 10 codes were used to identify diagnoses and procedures. Results: A total of 1,779 patients with gastric malignancy underwent total gastrectomy. The 30-day readmission rate was 18.5%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Readmitted patients were more likely to be on chemotherapy. (40.1% vs 27.2%; P&lt;0.01) and more likely to be discharged to a skilled facility (13.5% vs 17.9%; P&lt;0.01). The total health care in-hospital economic burden of readmission was $6.5 million in total charges and $25 million in total costs. Independent predictors of readmission were major bleeding, respiratory failure requiring mechanical ventilation, peripheral parenteral nutrition, history of non-alcoholic hepato-steatosis, and prolonged length of stay. Conclusions: Readmissions after gastrectomy in patients with gastric malignancies are associated with lower in-hospital mortality yet pose a substantial economic burden on healthcare. The lower mortality might be explained by the relatively stable course and lower comorbidities of patients who become eligible for discharge after surgery. Further studies are suggested. Modifiable risk factors like malnutrition and sepsis warrant special attention to decrease readmissions and improve overall outcomes.[Table: see text]

Impact and predictors of readmission in hypercalcemia of malignancy: Findings of a nationwide analysis.

e18809 Background: Hypercalcemia of malignancy (HCM) is common in cancer. It is a sign of advanced malignancy and associated with poor outcomes. Although a well-known phenomenon, treatment options are limited and recurrence leading to readmissions is common, increasing morbidity and mortality. We attempt to explore the mortality, healthcare resource utilization, 30-day readmission rate and independent predictors of readmission for HCM. Methods: We queried the 2017 National Readmission Database (NRD) of adults readmitted within 30 days after index admission for HCM with a concomitant diagnosis of solid tumors. T test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. Results: A total of 14,323 patients with solid tumors were admitted with HCM. The 30-day readmission rate was 24.9%. Common causes for readmission were sepsis, respiratory failure, hypercalcemia, distant metastases and AKI. At 30 days, readmitted patients were less likely to be discharged compared to patients admitted initially due to hypercalcemia (27.4 vs 30.8%; P&lt;0.01). Readmitted patients had a higher in-hospital mortality at 30 days (1.5 vs. 0.1%; P&lt;0.01), more incidence of chemotherapy induced pancytopenia (3.8 vs 2.5%; P&lt;0.01), mechanical ventilation (5.8 vs 4.7%; P=0.05) and venous thromboembolism (8.3 vs 5.9%; P&lt;0.01). Total economic burden of readmission was $251 million in total charges and $62.6 million in total costs. Adjusting for age and comorbidities, independent predictors of readmission were anemia of chronic disease, iron deficiency anemia and obesity. Conversely, predictors for lower odds of readmission were disposition to skilled facility and discharge with home health care services (Table). Conclusions: Nationally, HCM has a high rate of readmissions with increased morbidity and mortality making it a consequential healthcare burden. Among causes of readmission, potentially targetable include AKI and sepsis while among readmission predictors, iron deficiency anemia and anemia of chronic disease warrant further attention. Similarly, negative predictors highlight the importance of proper disposition planning and supportive care in malignancy.[Table: see text]

Predictors of 30-day readmission rate after liver transplant in patients with hepatocellular carcinoma.

e16193 Background: Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) in patients within the Milan criteria. Readmissions are common postoperatively, and can be associated with increased morbidity and healthcare burden. Hence we aim to identify incidence, impact and independent predictors for readmission in patients who underwent LT in HCC. Methods: Retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for LT with an underlying diagnosis of HCC, in patients with cirrhosis we used the BAVENO score to categorize between compensated and decompensated cirrhosis. We aim to identify 30-day readmission rate, mortality, healthcare related utilization resources and independent predictors of readmission. Results: A total of 2,092 patients with HCC underwent liver transplantation. The 30-day readmission rate was 25.6%. Main causes for readmission were post-surgical complications from LT, sepsis, liver failure. Readmitted patients were less likely to have private insurance (40.5% vs 34.5%; P&lt;0.01), to be obese (18.2% vs 7.9%; P&lt;0.01), hypertensive (51.2% vs 39.5%; P&lt;0.01), have history of non-alcoholic steatohepatitis (16.5% vs 2.3%; P&lt;0.01). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P&lt;0.01). The total health care in-hospital economic burden of readmission was $56.1 million in total charges and $15.2 million in total costs. Independent predictors of readmission were type 2 diabetes, transfusion of blood products during index admission, protein-caloric malnutrition, sepsis, and preventive factors were younger age, private insurance and cannabis use. Conclusions: Readmissions after LT in HCC are associated with higher mortality and pose a high health care burden. We identified risk factors that can be targeted to decrease overall patient morbidity, mortality and health care burden.[Table: see text]

Thirty-day readmission after percutaneous coronary intervention with drug eluting stent in patients with active malignancy.

e18601 Background: Reducing the 30-day readmission is one of the quality performance measures upon which hospitals are being evaluated. Readmissions represent a significant economic burden to the patients and the health care system. Index admission for myocardial infarctions requiring PCI with a concurrent diagnosis of malignancy represents a critical part of the population due to the association between cancer and the pro-thrombotic state that renders them at high risk of readmission. By harnessing the power of large datasets such as the NRD (National Readmission Database), we sought to find associations that, together, could aid in the development of better public and private policies that would make patient care more efficient. Methods: We conducted a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for myocardial infarction requiring PCI with a concurrent diagnosis of malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent readmission predictors. Results: A total of 8,350 patients with malignancy underwent PCI. The 30-day readmission rate was 17.8%. The main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Compared to initial admissions, readmitted patients were less likely to require mechanical ventilation (7.3% vs. 5.2%; P = 0.05), intra-aortic balloon pump placement (4.1 vs 0.4; P &lt; 0.01), IMPELLA device use (4.0 vs 0.3; P &lt; 0.01), less had private insurance (16.2% vs 12.9%; P = 0.02), less developed shock (7.7% vs 3.2%; P &lt; 0.01), &amp; less had major bleeding (2.0% vs 0.1%; P &lt; 0.01). Readmission was associated with lower in-hospital mortality rate (1.5% vs. 0.1%; P &lt; 0.01), but more likely to require hemodialysis (4.3% vs 6.6%; P &lt; 0.01), &amp; have venous thromboembolism (VTE) (1.9% vs 3.2%; P &lt; 0.01). The total health care in-hospital economic burden of readmission was $937 million in total charges for patients and $224 million in total costs for hospitals. Independent predictors of readmission were female gender, the disposition to a short-term hospital or skilled nursing facility, prolonged length of stay, inpatient hemodialysis, and VTE episodes. Conclusions: Readmissions after PCI in patients with malignancy are associated with a lower in-hospital mortality rate but pose a high health care burden. We identified potential risk factors that, if targeted, could lead to a reduction in readmissions after PCI in cancer patients, &amp; therefore decrease health care costs.

Rates and Predictors of 30-Day Readmission in Adults with Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis in the US: A Nationwide Study

Introduction: Diabetic ketoacidosis (DKA) is an endocrinological emergency that may be associated with inpatient mortality. This hyperglycemic state is more common in type 1 diabetics (T1DM) as insulin deficiency promotes lipolysis and ketogenesis. Due to the difference in epidemiologic and comorbidity profiles between T1DM and other types of diabetes, it is important to investigate factors affecting this unique group. This study assessed the rate and predictors of readmission in adults with T1DM hospitalized for DKA.Methods: The National Readmission Database for 2017 was searched for hospitalizations involving persons 18 years or older with T1DM who were principally admitted for DKA from January 1 to November 30, 2017. Patients admitted electively or traumatic admissions were excluded from the analysis. Outcomes assessed were 30-day readmission rates, mortality, length of stay (LOS) and hospitalization charges (THC). Multivariate cox regression model was adapted to identify independent predictors of readmission.Results: A total of 91,625 hospitalizations involved adult with T1DM for DKA with 91,401 discharged alive. Of the patients discharged alive, the rate of 30-day readmission was 20.2%, involving 18,553 patients. A majority of patients had a principal readmission for DKA. Compared to the index admission, a 30-day readmission was associated with over two times the mortality rate (Risk ratio 2.06, 95% CI: 1.74 - 2.43, p<0.001). Readmission was associated with increased mean LOS in days (1.0, 95% CI: 0.9 - 1.2, p<0.001) and THC in USD (8217, 95% CI: 6940 - 9492, p<0.001). Independent predictors of readmission included female sex (Hazard Ratio [HR]: 1.14, 95% CI: 1.74 - 1.20, p<0.001), discharge against medical advice (HR: 1.54, 95% CI: 1.43 - 1.66, p<0.001), hypertension (HR: 1.28, 95% CI: 1.20 - 1.35, p<0.001), chronic kidney disease (HR: 1.13, 95% CI: 1.04 - 1.22, p<0.001) and anemia (HR: 1.42, 95% CI: 1.34 - 1.51, p<0.001). However, obesity (HR: 0.70, 95% CI: 0.62 - 0.79, p<0.001) and hyperlipidemia (HR: 0.92, 95% CI: 0.87 - 0.98, p=0.007) were associated with lower rate of readmission for DKA.Conclusion: About a fifth of T1DM patients hospitalized for DKA are readmitted within 30 days of discharge. A 30-day readmission following hospitalization for DKA is associated with higher inpatient mortality in this group. Hypertension, chronic kidney disease, and anemia are amongst the predictors of readmission in patients with DKA. However, comorbid obesity and hyperlipidemia were associated with lower rates of readmissions. Healthcare utilization costs are significantly higher in readmitted patients compared to index admissions for DKA. Efforts should be channeled towards identifying these predictors in hospitalized patients as well as proper discharge planning to decrease the burden of readmissions.

388 Rate of psoriasis readmission has decreased in the united states: A 9- year longitudinal nationwide study

This study aims to study longitudinal trends of 30-day readmissions of psoriasis patients over time in the United States (US) using national population data. Data were obtained from the National readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis of NRD 2010 (year of inception)-2018 databases. We searched for index hospitalizations for patients aged≥ 18 years with a principal or secondary diagnosis of psoriasis using ICD codes for the corresponding year. We excluded elective and traumatic readmissions. The trend in the 30-day readmission rate was our primary outcome. Multivariate logistic and linear regression was used to calculate adjusted p-trend for categorical and continuous outcomes, respectively. The rate of decrease in 30-day readmission rate was steeper for patients admitted with a principal diagnosis of psoriasis (16.7% in 2010 to 10.2% in 2018, adjusted p-trend=0.002) compared to patients admitted with any diagnosis of psoriasis (12.2% in 2010 to 10.4% in 2018, adjusted p-trend<0.0001). Inpatient mortality of readmissions decreased from 4.4% in 2010 to 4.2% in 2018, with a nadir of 3.8% in 2016 (adjusted p-trend<0.0001). The mean length of stay (LOS) decreased from 6.3 days in 2010 to 5.8 days in 2018 (adjusted p-trend<0.0001). Proportion of readmitted patients with Charleston index score ≥3 increased from 0% in 2010 to 51.6% in 2018 (adjusted p-trend<0.0001). Adjusted total hospital cost increased from 13,636 to 14,112 US dollars (adjusted p-trend=0.010). Sepsis was the most common reason for readmission across all years. The rate of readmission has decreased for patients admitted principally because of psoriasis and all admissions of psoriasis patients; however, this decrease is more precipitous for the former. Although hospital cost and comorbidity burden of psoriasis readmissions has increased over time, inpatient mortality and LOS have decreased. These may be due to better outpatient management and more effective treatment options available in recent times.

Readmissions after cholecystectomy in a tertiary UK centre: Incidence, causes and burden.

Context:Although cholecystectomy is a widely performed procedure, post-operative readmissions place a heavy burden on healthcare facilities.Aims:This study assesses the incidence, causes and burden of 30-day readmissions after cholecystectomy in a tertiary UK centre.Settings and Design:This study was conducted at a university hospital, and the study design involves retrospective cohort study.Materials and Methods:Information was obtained from our prospectively maintained database and hospital's computerised records.Statistical Analysis:The encounters are expressed in numbers and percentages. The hospital stay, body mass index and age are expressed in mean, standard deviation (SD), min-max and median. Microsoft Excel® was used to calculate the means, SD, min-max and median.Results:Out of the 1140 cholecystectomies performed over this time, there were 75 true readmissions and 29 revisits; thus, the actual readmission rate is 6.58%. Non-specific abdominal pain ± deranged liver function test (LFT) is the most common cause of readmissions/ revisits in (38; 36.54%) cases, followed by (18; 17.31%) wound infections and (12; 11.54%) collections/bile leaks/abscess. This cost the centre 93 scans, 30 procedures and 295 days of hospital stay.Conclusions:Non-specific abdominal pain ± deranged LFT is the most common cause of readmissions/revisits in the centre. Readmissions after a cholecystectomy are a significant encumbrance.

The burden of readmission after discharge from necrotizing soft tissue infection.

The need for extensive surgical debridement with necrotizing soft tissue infections (NSTIs) may put patients at high risk for unplanned readmission. However, there is a paucity of data on the burden of readmission in patients afflicted with NSTI. We hypothesized that unplanned readmission would significantly contribute to the burden of disease after discharge from initial hospitalization. The Nationwide Readmission Database was used to identify adults undergoing debridement for NSTI hospitalizations from 2010 to 2017. Risk factors for 90-day readmission were assessed by Cox proportional hazards regression. There were a total of 82,738 NSTI admissions during the study period, of which 25,076 (30.3%) underwent 90-day readmissions. Median time to readmission was 25 days (interquartile range, 9-49 days). Fragmentation of care, longer length of index stay (>2 weeks), and Medicaid status were independent risk factors for readmission. Median cost of a readmission was US $10,543. Readmission added 174,640 hospital days to episodes of care over the study period, resulting in an estimated financial burden of US $1.4 billion. Unplanned readmission caused by NSTIs is common and costly. Interventions that target patients at risk for readmission may help decrease the burden of disease. Economic/Epidemiological, level IV.

The Burden of Readmissions in the First Year with an LVAD: Predictors and Associated Quality of Life Outcomes

Purpose The purpose of this study is to determine pre-operative indicators associated with longer hospital stays in the first year post-LVAD implant impact on quality of life. We hypothesized that patients with more high risk features pre-implant would require longer and more frequent hospitalizations and that their quality of life with be lower post-implant. Methods We performed a retrospective analysis of LVAD patients from our institution from 2017 to 2019 who survived the initial implant hospital stay and to one year on support. Descriptive statistics and logistic regression modeling were performed with STATA 15.1. Results 95 patients were included in the study population (78% men, average age 59 years). Patients’ burden of hospitalization was analyzed two ways: 1) total number of days spent inpatient in the first year post-LVAD implant, including both the initial implant and readmissions (mean = 37.1, SD = 25.3) and 2) total days readmitted in the first year post-implant from initial discharge (mean = 14.3 days, SD = 18.1). Pre-implant BMI was higher in patients who were readmitted for more days (coefficient = 0.825, p = 0.019). Pre-implant creatinine was higher in patients who had a greater number of days readmitted (coefficient = 9.13, p = 0.023) and greater total number of days inpatient (coefficient = 11.4, p = 0.048). Patients who spent greater total time in the hospital post-implant also had lower pre-operative INTERMACS scores (coefficient = -7.37, p = 0.008). Patients also completed the EuroQoL EQ-5D at 1 year, where they were asked about their satisfaction with the outcome of their VAD surgery. Patients with higher total numbers of days inpatient during their first year post-implant reported lower satisfaction on this question (coefficient = -0.065, p = 0.004). Other components of the EuroQoL were not significantly different. Conclusion Pre-operative creatinine and INTERMACS profile are associated with higher total number of days spent in the hospital in the first year post-LVAD implant (initial implant and readmission) and higher BMI is associated with greater readmission days. There is also an association between greater number of days spent in the hospital and decreased satisfaction post-implant. This highlights the need to establish greater supports for the high risk LVAD patient populations to improve post-implant quality of life.

Groove pancreatitis has a spectrum of severity and can be managed conservatively

Background & aimsThe natural history of groove pancreatitis is incompletely characterized. Published literature suggests a high rate of surgery. We describe the short- and long-term outcomes in a cohort of patients with groove pancreatitis treated at our institution. MethodsMedical records of patients hospitalized in the University of Pittsburgh Medical Center system from 2000 to 2014 and diagnosed with groove pancreatitis based on imaging were retrospectively reviewed. Clinical presentation and outcomes during index admission and follow-up were recorded. ResultsForty-eight patients with groove pancreatitis were identified (mean age 53.2 years, 79% male). Seventy-one percent were alcohol abusers and an equal number were cigarette smokers. Prior histories of acute and chronic pancreatitis were noted in 30 (62.5%) and 21 (43.8%), respectively. Forty-four (91.7%) met criteria for acute pancreatitis during their index admission. Alcohol was the most common etiology (68.8%). No patient experienced organ failure. The most frequent imaging findings were fat stranding in the groove (83.3%), duodenal wall thickening (52.1%), and soft tissue mass/thickening in the groove (50%). Over a mean follow-up of 5.0 years, seven (14.6%) required a pancreas-related surgery. Patients had a high burden of pancreatitis-related readmissions (68.8%, 69.4/100 patient-years). Incident diabetes and chronic pancreatitis were diagnosed in 5 (13.9% of patients at risk) and 8 (29.6% of patients at risk) respectively. ConclusionsGroove pancreatitis has a wide spectrum of severity; most patients have mild disease. These patients have a high burden of readmissions and progression to chronic pancreatitis. A small minority requires surgical intervention.

Readmission following extracranial-intracranial bypass surgery in the United States: nationwide rates, causes, risk factors, and volume-driven outcomes.

Extracranial-intracranial (EC-IC) bypass surgery remains an important treatment option for patients with moyamoya disease (MMD), intracranial arteriosclerotic disease (ICAD) with symptomatic stenosis despite the best medical management, and complex aneurysms. The therapeutic benefit of cerebral bypass surgery depends on optimal patient selection and the minimization of periprocedural complications. The nationwide burden of readmissions and associated complications following EC-IC bypass surgery has not been previously described. Therefore, the authors sought to analyze a nationwide database to describe the national rates, causes, risk factors, complications, and morbidity associated with readmission following EC-IC bypass surgery for MMD, ICAD, and aneurysms. The Nationwide Readmissions Database (NRD) was queried for the years 2010-2014 to identify patients who had undergone EC-IC bypass for MMD, medically failed symptomatic ICAD, or unruptured aneurysms. Predictor variables included demographics, preexisting comorbidities, indication for surgery, and hospital bypass case volume. A high-volume center (HVC) was defined as one that performed 10 or more cases/year. Outcome variables included perioperative stroke, discharge disposition, length of stay, total hospital costs, and readmission (30 days, 90 days). Multivariable analysis was used to identify predictors of readmission and to study the effect of treatment at HVCs on quality outcomes. In total, 2500 patients with a mean age of 41 years were treated with EC-IC bypass surgery for MMD (63.1%), ICAD (24.5%), or unruptured aneurysms (12.4%). The 30- and 90-day readmission rates were 7.5% and 14.0%, respectively. Causes of readmission included new stroke (2.5%), wound complications (2.5%), graft failure (1.5%), and other infection (1.3%). In the multivariable analysis, risk factors for readmission included Medicaid/self-pay (OR 1.6, 95% CI 1.1-2.4, vs private insurance), comorbidity score (OR 1.2, 95% CI 1.1-1.4, per additional comorbidity), and treatment at a non-HVC (OR 1.9, 95% CI 1.1-3.0). Treatment at an HVC (17% of patients) was associated with significantly lower rates of nonroutine discharge dispositions (13.4% vs 26.7%, p = 0.004), ischemic stroke within 90 days (0.8% vs 2.9%, p = 0.03), 30-day readmission (3.9% vs 8.2%, p = 0.03), and 90-day readmission (8.6% vs 15.2%, p = 0.01). These findings were confirmed in a multivariable analysis. The authors estimate that centralization to HVCs may result in 333 fewer nonroutine discharges (50% reduction), 12,000 fewer hospital days (44% reduction), 165 fewer readmissions (43%), and a cost savings of $15.3 million (11% reduction). Readmission rates for patients after EC-IC bypass are comparable with those after other common cranial procedures and are primarily driven by preexisting comorbidities, socioeconomic status, and treatment at low-volume centers. Periprocedural complications, including stroke, graft failure, and wound complications, occurred at the expected rates, consistent with those in prior clinical series. The centralization of care may significantly reduce perioperative complications, readmissions, and hospital resource utilization.

Trends in cause-specific readmissions in heart failure with preserved versus reduced and mid-range ejection fraction

Abstract Background It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF). Methods We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions. Results Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values&amp;gt;0.05). Conclusions Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.

Economic burden of readmission due to postoperative cerebrospinal fluid leak in Chinese patients.

Aim: This real-world datastudy investigated the economic burden and associated factors of readmissions for cerebrospinal fluid leakage (CSFL) post-cranial, transsphenoidal, or spinal index surgeries. Methods: Costs of CSFL readmissions and index hospitalizations during 2014-2018 were collected. Readmission cost was measured as absolute cost and as percentage of index hospitalization cost. Factors associated with readmission cost were explored using generalized linear models. Results: Readmission cost averaged US$2407-6106, 35-94% of index hospitalization cost. Pharmacy costs were the leading contributor. Generalized linear models showed transsphenoidal index surgery and surgical treatment for CSFL were associated with higher readmission costs. Conclusion: CSFL readmissions are a significant economic burden in China. Factors associated with higher readmission cost should be monitored.

Association of Short-Term PM2.5 with Hospital Readmissions in Heart Failure Patients in North Carolina, USA

Background/Aim: Short-term changes in ambient fine particulate matter (diameter ≤ 2.5 μm, PM2.5) air pollution increase the risk for hospital admission and readmission. Additional research is needed to understand these risks in individuals with underlying cardiovascular disease. Here, we measure the PM2.5-realted readmission risk in heart failure (HF) patients and examine how this risk varies with respect to time following discharge. Methods: The study cohort included 17,674 HF patients (49,835 inpatient hospitalizations) admitted to a University of North Carolina-affiliated hospital between July 2004 and December 2016. Daily ambient PM2.5 was estimated using a neural network with 1km resolution. Time-dependent Cox proportional hazards models estimated the association between daily ambient PM2.5 and the risk of a 30-day readmission (any cause) after adjusting for sex, race, age, prior hospital visits, temperature, relative humidity, length of stay, and discharge day. Time-dependent readmission risk was addressed by examining two time windows: early (1-7d) and late (8-30d) readmissions. Results are expressed as the hazard ratio per 10 μg/m3 increase in same day PM2.5. Results: The 30-day readmission risk associated with a 10 μg/m3 increase in same day PM2.5 was on average increased by 2.8% (95% CI: -0.9-6.6%), but varied based on the time since discharge. PM2.5-realted readmission risks were greatest during the early time period (1-7d), where a 10 μg/m3 increase in PM2.5 was associated with a 6.2% (95% CI: 0.03-12.4%) increased readmission risk. Readmissions occuring 8-30 days after discharge had weaker associations with PM2.5 that included the null (2.8%, 95% CI: -1.4-7.5%). Conclusions: Elevated daily PM2.5 is associated with increased risk of a 30-day hospital readmission, particularly in the first week following hospital discharge. Our results suggest that reducing exposure to PM2.5 could reduce the burden of frequent readmissions on patients and the healthcare system. This abstract does not reflect EPA policy.

INCIDENCE AND PREDICTORS OF 30-DAY READMISSION IN PATIENTS HOSPITALIZED WITH ASPIRATION PNEUMONIA

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Aspiration pneumonia is a subtype of pneumonia caused by large-volume aspiration of oropharyngeal colonization or gastric content. Our study aimed to estimate the rate, risk factors, and costs associated with 30- day readmissions after aspiration pneumonia hospitalizations in a large, nationally representative cohort. METHODS: We analyzed the 2016 and 2017 U.S. National Readmission Database (NRD) to identify adult patients admitted with a principal diagnosis of aspiration pneumonia. A readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. We examined the baseline demographics, national readmission rates, resource utilization. We used the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM) to identify the diagnosis. Multivariate logistic regression was used to identify predictors of 30- day readmission. RESULTS: A total of 252,904 patients admitted with aspiration pneumonia were identified. The mean age was 73.8. 43.7% of patients were female. 35% of patients had dysphagia, 26.9% had dementia, 17% had altered mental status, 13.3% had palliative care encounter. The all-cause 30-day readmission rate was 17%. The in-hospital and 30-day mortality rate was 7.9% and 9.2%, respectively. The in-hospital mortality rate for readmitted patients was 9.4%. The most common five reasons for all-cause readmission were aspiration pneumonia, sepsis, unspecified pneumonia, acute kidney injury, chronic obstructive pulmonary disease with (acute) exacerbation. After adjusting for multiple covariates, readmission within 30 days was independently associated with higher Charlson comorbidity score [adjusted odds ratio (aOR) 1.1, 95% confidence interval (CI) 1.10- 1.12, p<0.001], dysphagia (aOR 1.1, 95% CI 1.06- 1.14, p<0.001). Female sex (aOR 0.93, 95% CI 0.89- 0.96, p<0.001), palliative encounter (aOR 0.37, 95% CI 0.34- 0.40, p<0.001), higher income (aOR 0.92, 95% CI 0.87- 0.97, p<0.001), using private insurance (aOR 0.74, 95% CI 0.69- 0.79, p<0.001), alcohol use (aOR 0.90, 95% CI 0.83- 0.98, p=0.016), dementia (aOR 0.82, 95% CI 0.78- 0.85, p<0.001) were associated with decreased all-cause readmissions. The mean length of stay (LOS) of index admissions and readmissions was 6.62 vs 6.71 days (p=0.122), and the mean cost was $13,987 vs. $14,598 (p<0.001). CONCLUSIONS: Patients admitted for aspiration pneumonia were frequently readmitted to the hospital within 30 days after discharge. We found a significant burden of 30-day readmissions, including higher in-hospital mortality rate and resource utilization. CLINICAL IMPLICATIONS: Our findings might be used to develop strategies to reduce early readmission of aspiration pneumonia. Additional attention should be directed toward these patients in the form of careful discharge planning and a multidisciplinary approach to swallowing management. DISCLOSURES: No relevant relationships by Si Li, source=Web Response No relevant relationships by Bojana Milekic, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Yichen Wang, source=Web Response