Cause Of Readmission Research Articles

Racial/Ethnic Differences in Association Between Medicaid Expansion and Causes and Costs of Readmission After Acute Ischemic Stroke.

The purpose of this study was to examine whether the relative frequency of leading causes and total associated costs of readmission after acute ischemic stroke changed with Medicaid expansion, and how these changes differed by racial/ethnic group. We used a difference-in-differences approach to compare changes in the relative frequency of leading causes of unplanned 30-day readmission and to examine changes in the costs associated with unplanned readmission between expansion states (AR, MD, NM, and WA) and non-expansion states (FL and GA). To estimate the differential effect of Medicaid expansion by race/ethnicity on the causes and cost of readmission, we added a time*treatment*race interaction. Multinomial logistic regression was performed to analyze the changes in readmission cause. Gamma log-link modeling was used to study changes in readmission costs for expansion compared to non-expansion states. The final multinomial model showed an association between expanded Medicaid and the relative frequency of sepsis readmission for White patients. According to predictive margins, White patients in expansion states had an estimated increase of 3.3 percentage points in the share of readmissions for sepsis but not for White patients in non-expansion states. In contrast, non-White patients in expansion states had a decrease of 1.8 percentage points in the share of readmissions for sepsis. Overall, Medicaid expansion was associated with a net increase of 6.7 percentage points in the share of readmissions for sepsis among non-Hispanic Whites relative to all other groups. In the final gamma model, Medicaid expansion was associated with a decrease in readmission costs overall. According to predictive margins, the net cost reduction in expansion versus non-expansion states was an average of $2509. Medicaid expansion is associated with an overall decrease in unplanned readmission costs and an increase among readmitted White patients in the likelihood of readmission for sepsis.

Causes and predictors of unplanned hospital readmission in inflammatory bowel disease patients

Background: Inflammatory bowel disease (IBD) is a chronic disease that involves ulcerative colitis (UC) and Crohn's disease (CD). Patients with IBD experience frequent admissions to the hospital. Readmission carries a potential burden to the health care system and has negative impacts on the patients. Readmissions can be reduced by identifying the causing factors. This study aimed at identifying the reasons for readmission in adult patients with IBD at King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Methods: A retrospective cohort study enrolled adult patients with confirmed IBD. The collected data included patients' demographics, co-morbidities, laboratory tests, type of IBD, number of readmissions in 1 week, 3 months, 6 months, and per year, reasons for readmission, intervention, and outcomes. Statistical Package for the Social Sciences software version 21 was used to analyze the collected data. Results: A total of 247 IBD patients were included; 58.3% had CD, and 41.7% had UC. There were 84.2% reported 1–2 times readmissions. Abdominal pain and diarrhea were the major causes of admission in the first readmission (73.7% and 58.7%, respectively), second readmission (30.8% and 17.4%, respectively), third admission (12.6% and 9.7%, respectively), and fourth admission (8.5% and 7.3%, respectively). Conclusion: There were various causes of hospital readmissions among IBD patients, yet the major and most common causes of readmission among the four studied readmissions were abdominal pain and diarrhea. The least common reasons varied between the different readmissions.

READMISSÃO NÃO PLANEJADA EM 30 DIAS APÓS CIRURGIAS DA COLUNA: ANÁLISE DE 650 CASOS

ABSTRACT Objective: Postoperative readmission rates can be used to assess hospital care quality. The rates of unplanned readmission within 30 days after spine surgery are variable in the literature, and no studies have evaluated such rates in a single Latin American center. This study aimed to assess the rate of unplanned hospital readmission within 30 days after a spine surgery at a single Brazilian institution and to identify possible risk factors. Methods: Patients who underwent spine surgery at a single private hospital between January 2018 and December 2020 were retrospectively analyzed, and those with unplanned readmissions within 30 days of discharge were identified. Risk factors were determined, and the reoperation rate was assessed. Results: 650 patients were included in the analysis, and 74 (11.28%) were readmitted within 30 days after surgery. Higher readmission rates were observed after vertebroplasty and surgeries involving spinal or bone tumors. The risk factors found in the series were older age, longer hospital stays, higher ASA scores, instrumented surgeries, diabetes mellitus, and surgeries involving primary or secondary spinal tumors. The most common causes of unplanned readmission were infection and pain. Of the readmissions, 28.37% required a return to the operating room. Conclusions: This study suggests infection and pain management were the most common causes of unplanned readmission after spine surgery. Strategies to improve perioperative and postoperative care are required to reduce unplanned readmissions. Level of Evidence III; Retrospective Comparative Study.

ANALYSIS OF READMISSIONS TO NEUROSURGERY INTENSIVE CARE UNIT

Background. Around 10% of patients in developed coun­tries are readmitted to the Intensive care unit during the same hospitalisation each year [1,2]. Readmission is as­sociated with increased length of stay, risk of morbidity and mortality and higher hospital costs [1,3]. Finding out the factors increasing the risk of readmission is es­sential to predict which patients will return to the ICU. Aim. To analyse the incidence and causes of readmissions to the NICU and to assess the impact of readmissions on patients’ outcomes. Methods. A retrospective single-center chart review of 90 patients readmited to the Neurosurgery intensive care unit (NICU) of the Hospital of Lithuanian University of Health Sciences (LUHS) “Kaunas Clinics“ from January 1st to December 31st of 2020, was performed. Demografic and clinical variables such as: admission diagnosis, tim­ing and indications for readmissions, length of NICU stay during readmission, presence of infection, the need for vasopressors and mechanical ventilation (MV) were assessed. Results. 1598 patients were admitted to the NICU in 2020. 90 case histories of readmitted patients were an­alyzed. Patients were divided into survivors and non-survivors groups. 46 (51.50%) of patients were males, the average age was 63.68 (SD 15.89) years. Most fre­quent indications for readmission were respiratory failure (25.56%), reoperation (24.44%), neurological reasons (21.11%, e.g. decreased state of consciousness, status epilepticus). The readmission rate was 5.63%. The mor­tality rate of readmitted patients was 22.50% (the overall mortality in the NICU in 2020 – 10.40%). Presence of nosocomial infection and MV were associated with lon­ger length of stay in the NICU (p < 0.05). Higher mor­tality was related to worse state of consciousness at the time of readmission to the NICU, presence of nosocomial infection, need for vasopressors and/or MV (p < 0.05). Conclusions. The rate of readmission to the NICU was 5.63%. The most common causes for readmission to the NICU were: respiratory failure, reoperation, and neuro­logical indications. The mortality rate of patients that were readmitted to the NICU was higher than overall mortality. Respiratory failure, the need for vasopressors, mechanical ventilation, and hospital-acquired infection were related to worse outcomes.

Etiologies and Predictors of 30-Day Readmission in Heart Failure: An Updated Analysis.

Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions. National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed. Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had higher proportion of males (56.3% vs. 53.7%), lowest income quartiles (33.3% vs. 28.9%), Charlson comorbidity index (CCI) ≥3 (61.7% vs. 52.8%), resource utilization including large bed-size hospitalizations, Medicaid enrollees, mean length of stay (6.2 vs. 5.4 days), and disposition to other facilities (23.9% vs. 20%) than non-readmitted. Readmission (30-day) rate was 21.2% (10,370) with cardiovascular causes in 50.3% (HF being the most common: 39%), and non-cardiac in 49.7%. Independent predictors for readmission were male sex, lower socioeconomic status, nonelective admissions, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, anemia, and CCI ≥3. HF-specific readmissions were significantly associated with prior coronary artery disease and Medicaid enrollment. Our analysis revealed cardiac and noncardiac causes of readmission were equally common for 30-day readmissions in HF patients with HF itself being the most common etiology highlighting the importance of addressing the comorbidities, both cardiac and non-cardiac, to mitigate the risk of readmission.

Recent advances in the treatment of biofilms induced surgical site infections.

Recent advances in the treatment of biofilms induced surgical site infections.

Association of Maternal Factors with hyperbilirubinaemia in Newborns at a Tertiary Care Hospital in Navi Mumbai, India: A Cross-sectional Study

Introduction: Hyperbilirubinaemia in newborns is a common and serious condition, and it is also one of the most common causes of neonatal readmission to the hospital. It is challenging to diagnose or predict the onset of hyperbilirubinaemia in newborns. Therefore, identifying neonates with maternal risk factors is useful for early prediction of hyperbilirubinaemia, enabling effective management and prevention of complications such as acute bilirubin encephalopathy or kernicterus. Aim: To estimate the prevalence of neonatal hyperbilirubinaemia and its association with various maternal risk factors such as parity, maternal diseases, blood group incompatibility, mode of delivery, etc. Materials and Methods: This hospital-based descriptive, cross-sectional study was conducted at Dr. D.Y. Patil Hospital in Navi Mumbai, Maharashtra, India, from December 2021 to December 2022. A total of 500 healthy full-term neonates and their mothers were screened. Neonates with hyperbilirubinaemia during follow-up were evaluated. Data on maternal factors (e.g., parity, maternal diseases, polyhydramnios, premature rupture of membranes, ABO and Rh incompatibility) were collected, and their association with neonatal hyperbilirubinaemia was assessed. Statistical analysis of the data was performed using the Chi-square test to determine prevalence and significance. Results: Out of the 500 babies studied, 95 had serum total bilirubin levels beyond the acceptable normal level of 13 mg/dL at 72 hours of life. The prevalence of hyperbilirubinaemia was 19%. Among the 95 babies, 40 (42.1%) were born to primigravida mothers, while 55 (57.9%) were born to multigravida mothers. In the present study, the authors observed that out of the 26 mothers suffering from hypothyroidism, 14 babies developed hyperbilirubinaemia. Similarly, out of the 24 mothers with preeclampsia, eight babies developed hyperbilirubinaemia. Furthermore, out of the 15 mothers with diabetes mellitus, six babies developed hyperbilirubinaemia. Additionally, out of the 11 mothers with polyhydramnios, two babies developed hyperbilirubinaemia, and out of the 10 mothers with Premature Rupture of Membranes (PROM), one baby developed hyperbilirubinaemia. Among the 208 male neonates, 58 developed hyperbilirubinaemia, while among the 292 female neonates, 37 developed hyperbilirubinaemia. ABO incompatibility was seen in 23 (24.2%) neonates, and Rh incompatibility was seen in 3 (3.2%) neonates, both of which were identified as important risk factors. A higher incidence of hyperbilirubinaemia was observed in neonates born via Lower Segment Caesarean Section (LSCS) compared to normal vaginal delivery. Conclusion: In the present study, the prevalence of neonatal hyperbilirubinaemia was 19%. Male babies, babies born via LSCS, those with ABO incompatibility, and mothers with hypothyroidism were significantly more prone to develop hyperbilirubinaemia in neonates.

National Analysis of Sternal Wound Complications and Readmissions After Coronary Bypass Surgery

BackgroundWound complications are a cause for readmission after cardiac surgery. Health insurance status has been associated with poor postoperative outcomes. We investigate the association between health insurance status and post-CABG wound dehiscence or infection along with 30-day wound-related readmission using a national database. MethodsWe queried the National Readmissions Database for the year 2018 for patients aged 18 years or more undergoing multivessel coronary artery bypass graft surgery (CABG). Patients were subcategorized by health insurance status (private, Medicaid, Medicare, uninsured). Our primary outcomes were wound dehiscence or infection during the index admission and 30-day readmission after discharge for wound-related complications. ResultsIn all, 131,976 patients met inclusion criteria: 32.7% private, 7.6% Medicaid, 59.3% Medicare, and 0.4% uninsured. Compared with patients having private insurance, Medicaid patients had greater odds of readmission for superficial wound dehiscence (odds ratio [OR] 2.11; 1.11-4.00; P = .022) and deep wound dehiscence (OR 2.11; 95% CI, 1.09–4.10; P = .026), as did Medicare patients (OR 2.34; 95% CI, 1.29-3.88; P = .004; and OR 3.23; 95% CI, 1.76-5.90; P = .001, respectively). Medicaid patients additionally had higher odds of readmission for superficial wound infection (OR 1.59; 95% CI, 1.11-4.00; P = .014). Compared with patients with private insurance, Medicaid patients had higher odds of deep wound dehiscence on index admission (OR 1.97; 95% CI, 1.02-3.83; P = .044), and Medicare patients had higher odds of superficial wound dehiscence (OR 2.55; 95% CI, 1.28-5.06; P = .001). ConclusionsPatients with Medicaid and Medicare had greater odds of readmission for wound complications and higher rates of wound dehiscence in their index admission. Further research is warranted to characterize factors driving readmission due to postsurgical wound complications in low socioeconomic status populations.

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.

Immunodeficiencies Push Readmissions in Malignant Tumor Patients: A Retrospective Cohort Study Based on the Nationwide Readmission Database

Immunodeficiency diseases (IDDs) are associated with an increased proportion of cancer-related morbidity. However, the relationship between IDDs and malignancy readmissions has not been well described. Understanding this relationship could help us to develop a more reasonable discharge plan in the special tumor population. Using the Nationwide Readmissions Database, we established a retrospective cohort study that included patients with the 16 most common malignancies, and we defined two groups: non-immunodeficiency diseases (NOIDDs) and IDDs. To identify whether the presence or absence of IDDs was associated with readmission, we identified 603,831 patients with malignancies at their time of readmission in which 0.8% had IDDs and in which readmission occurred in 47.3%. Compared with NOIDDs, patients with IDDs had a higher risk of 30-day (hazard ratio (HR) of 1.32; 95% CI of 1.25-1.40), 90-day (HR of 1.27; 95% CI of 1.21-1.34) and 180-day readmission (HR of 1.28; 95% CI of 1.22-1.35). More than one third (37.9%) of patients with IDDs had readmissions that occurred within 30 days and most (82.4%) of them were UPRs. An IDD was an independent risk factor for readmission in patients with colorectal cancer (HR of 1.32; 95% CI of 1.01-1.72), lung cancer (HR of 1.23; 95% CI of 1.02-1.48), non-Hodgkin's lymphoma (NHL) (HR of 1.16; 95% CI of 1.04-1.28), prostate cancer (HR of 1.45; 95% CI of 1.07-1.96) or stomach cancer (HR of 2.34; 95% CI of 1.33-4.14). Anemia (44.2%), bacterial infections (28.6%) and pneumonia (13.9%) were the 30-day UPR causes in these populations. (4) Conclusions: IDDs were independently associated with higher readmission risks for some malignant tumors. Strategies should be considered to prevent the causes of readmission as a post discharge plan.

FREQUENT CAUSES OF 30-DAY READMISSION FOLLOWING A FIRST EPISODE OF HEART FAILURE IN OLDER ADULTS

Abstract Older adults with heart failure (HF) have a greater propensity to experience poor clinical outcomes, hospital readmission, and functional decline. It is important that healthcare workers are aware of the comorbidities that may lead to poor outcomes. A deeper understanding of potential causes of readmission will help in adequate prevention. Employing an all-payers claims database, we aimed to examine the diagnoses related to 30-day readmission in patients aged 65-75 with an Elixhauser-Comorbidity Index score < 4 upon the first episode of HF. Exclusion criteria included in-hospital death, readmissions for the same condition, and discharge against medical advice. Using ICD codes 9-10, a cohort of 323,678 patients (mean age: 70, SD: 3.22; male: 60%) with the first episode of HF between 2015-2019 were identified. We found 7,729 (2.4%) readmissions within 30 days and examined the frequency of 118 diagnoses as the primary cause. Cardiovascular etiologies including HF, hypertension, arrhythmias, and coronary artery disease were the most prevalent causes of readmission (40.64%), with HF being the most frequent (13.25%). Non-Cardiovascular causes included pulmonary (5.94%), sepsis (7%), renal (3.8%), and cerebrovascular (1.58%). Metabolic, liver, gastrointestinal diseases, and other infections accounted for 19.32%. Understanding the diagnoses related to readmissions in different populations is crucial for improving care, conducting research, and lowering costs. We focused on the first episode of HF in a relatively healthy older population to control for confounding factors. Further studies considering demographics, HF characteristics, and baseline comorbidities are needed.

425 THE IMPACT OF NURSING EDUCATION ON THE QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A SYSTEMATIC REVIEW

Abstract Introduction Heart failure (HF) occurs in 26 million people worldwide and is one of the most common causes of hospitalization, hospital readmission and death. To overcome this, ESC guidelines recommend the cardiologic rehabilitation pathway, which places the patient with HF at the center of his or her care pathway with the aim of improving quality of life through the implementation of a personalized multidisciplinary program. In the cardiology rehabilitation pathway, the nurse plays a key role of education and support, encouraging the patient to change. The aim of the review is to explore the quality of life of the elderly patient with HF and the educational role of nursing in the cardiac rehabilitation setting. Materials and Methods A systematic search was conducted using PUBMED, CINAHL until June 2022, according to REA methodology. The quality of the study was assessed by three reviewers using the DIXONWOOD checklist. Results and discussion: Analysis of the results suggests that multiple aspects need to be considered to improve the management and quality of life of patients with HF. Among these, the literature cites the implementation of a network of nurse case managers, standardization of operative protocols, mental and physical pain management, and cardiac rehabilitation units after hospital discharge. It also shows how physical activity, according to the ERIC-HF program, can improve the ability to perform ADL activities (Kang Y. et all, 2020). An additional study found that home cardiac rehabilitation intervention results in clinically significant improvement in disease-related quality of life in patients with HF. Cost-utility analyses support that home cardiac rehabilitation programs are cost-effective treatments for patients with HF and that nurses play a key role in educating and managing their condition (Rod s. et all, 2019). They should encourage patients with heart failure to practice cardiac rehabilitation for a longer period to improve their quality of life. One study shows that rehabilitation intervention for caregivers of patients with HF is helpful in supporting their role and improving their confidence (Wingham J. et all, 2019). Conclusions Cardiac rehabilitation in which nurses are present proves to be crucial in both psychological (Suzanne H et al, 2018) and exercise-enhancing projects to improve long-term health conditions, as shown by Kentaro, K., this approach produces benefits on patients with HF and their caregivers. It induces in the patient greater autonomy in daily activities, medication adherence and self-care of the disease, delaying its progression. At the same time, for caregivers there is a reduction in caregiver burden resulting in economic, emotional and social improvement. For the National Health Service, there is a reduction in length of stay in intensive care and emergency departments and consequently, a decrease in costs.

Predictors of Thirty-Day Hospital Readmissions in Systemic Lupus Erythematosus in the United States: A Nationwide Study.

To evaluate independent risk factors for readmission and to determine the major reasons for readmission in a nationally representative sample of patients with systemic lupus erythematosus (SLE). We used the Nationwide Readmissions Database to identify adults with SLE who were discharged from hospital to home during January-November of 2016 and 2017. Thirty-day all-cause readmissions were identified. A multivariable adjusted survey-specific logistic regression model was used to identify factors associated with readmission. A total of 132,400 hospitalized adults with SLE were discharged home during the study period; 88.3% were female, with a median age of 51.0 years (interquartile range 38.7-61.9 years). Of these, 18,973 individuals (14.3%) were readmitted within 30 days of discharge from their index hospitalization. In multivariable analyses, the factors associated with the highest odds for readmission were autoimmune hemolytic anemia (odds ratio [OR] 1.86 [95% confidence interval (95% CI) 1.51-2.29]), glomerular disease (OR 1.27 [95% CI 1.19-1.36]), pericarditis (OR 1.35 [95% CI 1.14-1.60]), heart failure (OR 1.34 [95% CI 1.24-1.44]), age 18-30 years (OR 1.28 [95% CI 1.17-1.41] versus age ≥​65 years), and Medicare (OR 1.20 [95% CI 1.13-1.28]) and Medicaid insurance (OR 1.26 [95% CI 1.18-1.34]). Sepsis (7.6%), SLE (7.4%), heart failure (3.5%), and pneumonia (3.2%) were among the most common causes for readmission. In this nationally representative study of SLE readmissions, the strongest risk factors for 30-day readmission were younger age, SLE-related manifestations, and public insurance. These results identify patient groups with SLE that would benefit from postdischarge interventions designed to reduce hospitalizations and improve health outcomes.

Factors Influencing Hospital Readmission after Lower Extremity Bypass for Chronic Limb-Threatening Ischemia.

Objectives: Unplanned hospital readmission is a leading source of hospital resource expenditure, and preventing readmission may improve both patient quality of life and healthcare costs. The factors influencing hospital readmission after lower extremity bypass (LEB) for chronic limb-threatening ischemia (CLTI) remain incompletely investigated. Methods: A regional, multi-institutional database was retrospectively reviewed for all patients who underwent LEB for CLTI between 1995 to 2020. The primary outcome was unplanned hospital readmission up to 30 days following bypass. Results: A total of 1315 patients underwent LEB across all institutions, of whom 843 (64.1%) underwent bypass for CLTI. The 30-day hospital readmission rate was 25.3%, and the leading causes of readmission were wound-related complications (51.6%). There was no difference in age, sex, or race between readmitted and non-readmitted patients. Conduit type and bypass target were also similar between groups. Readmitted patients more frequently underwent LEB for tissue loss (58.2% vs 50.2%, P = 0.042). On multivariable analysis, wound infection (odds ratio [OR] 9.1, 95% confidence interval [CI] 6.2-13.2, P < 0.001) and non-infectious wound complications (OR 2.0, 95% CI 1.0-3.9, P = 0.041) were independently associated with hospital readmission. Factors not associated with hospital readmission included patient age, conduit type, distal bypass target, and other medical comorbidities. Conclusions: One quarter of patients are readmitted within 30days following lower extremity bypass for chronic limb-threatening ischemia. Efforts to mitigate wound infection and non-infectious wound complications may decrease rates of unplanned hospital readmission.

Radical prostatectomy readmissions: Causes, risk factors, national rates, & costs

IntroductionReadmissions have substantial clinical and financial impacts on the healthcare system. Radical prostatectomy (RP) is considered a standard treatment in the management of clinically localized prostate cancer. Yet, there is a paucity of research evaluating readmissions for RP in a national dataset. Patients and methodsPatients with histologically confirmed prostate cancer managed with RP were identified within the 2016 to 2018 Nationwide Readmissions Database. Patient factors, facility factors, and surgical characteristics were evaluated for associations with readmission using univariable and multivariable analyses. ResultsA total of 133,727 patients receiving RP were identified. Early (30-day) and late (31–90-day) readmission rates were 4.2% and 1.8% respectively. The most common cause of early readmission was postoperative digestive system complication (10%) and the most common cause of late readmission was septicemia (13%). On multivariable logistic regression, factors associated with both early and late readmission include nonroutine discharge at index (early: OR 1.877, 95% CI 1.667–2.113; late: OR 1.801, 95% CI 1.490–2.183), and circulatory system comorbidity (early: OR 1.29, 95% CI 1.082–1.538); late: OR 1.515, 95% CI 1.157–1.984). ConclusionsOur findings regarding factors associated with readmission provide insight for RP counseling and may inform postoperative care pathways. Elucidation of readmission trends may allow the identification and proactive management of patients at higher risk for readmission.

Letter: Characteristics and Outcomes of Discharge Against Medical Advice and 30-Day Readmissions After Concussion: Analysis of the Nationwide Readmissions Database.

To the Editor: We read with immense interest the article by Jumah et al1 titled as “Characteristics and Outcomes of Discharge Against Medical Advice (DAMA) and 30-Day Readmissions After Concussion: Analysis of the Nationwide Readmissions Database.” It was indeed a fascinating and compelling study which attempted to assess the prevalence of DAMA and its effect on 30-day readmissions and cost in concussion using a nationally representative sample. The authors state that this is the first study to date to analyze DAMA in patients with mild traumatic brain injury (mTBI) and hence is a stepping stone in this arena. Prevalence rates reported (2.6%) were in accordance with other studies and so were the factors associated with DAMA: young men, an Elixhauser comorbidity index >3, and injuries due to assault and/or fall while higher income had a negative association with DAMA. Thirty-day readmission had an independent association with DAMA, higher comorbidity index, and self-inflicted mode of injury. Most frequently encountered cause of readmission was TBI in both routine and DAMA groups. This study can act as a reference to design interventions that can be implemented in real time at health care facilities to reduce DAMA and readmission rate and consequently morbidity and mortality associated with TBI. Although the study is very engrossing and interesting, we were hoping the authors would shed some light on a few areas that could have given more insight about the issue. The study strictly included only patients with mTBI to make sure of the patient's ability to choose DAMA, thereby excluding other patients with TBI. This was very thoughtful of the authors; however, the medical decision-making capacity of a patient with TBI, even if mild, is significantly affected for at least 1 month from injury as compared with a healthy control or patients with other mild illnesses2 and hence we feel that this might have led to confounded results. In addition, what would have been an interesting factor to study is the relationship between DAMA and patient's educational status .3 The authors have reported assault to have a significant association with DAMA. In many cases, women are a victim of assault and thereby female sex should have had an association with DAMA which was contradictory to the observed relation of male sex to DAMA. The study also failed to take into account the role of factors such as sociocultural beliefs of the patients, their family conditions, and their relation with the health care provider. This was most probably due to absence of such variables in the Nationwide Readmissions Database that was used to conduct this study. In addition, patients with mTBI have more emergency department visits which could not be captured by Nationwide Readmissions Database and hence readmission rates might have been confounded. Many studies have shown the negative impact of sociocultural practices on patients' health as they interfere with the scientific process of providing health care to the patients, especially in Asian and African communities.4 Having a child/elderly member at home to take care of or no one to accompany the patients during the stay in the hospitals could be some of the familial reasons for patients to leave against medical advice. Inclusion of ethnicity, gender identity, and the immigration status of the patients and their effect on DAMA would have been a novel addition to the study. Discrimination by the health care providers on the basis of patients' ethnicity and/or sex identity creates differences between the health care providers and the patients. Therefore, patients may feel secluded and disrespected which might be a probable cause of DAMA. For instance, African American patients were found to have 2-fold higher odds of DAMA as compared with White patients.5 Paperwork at the time of admission and the financial constraints create an obstacle for the illegal immigrants forcing them to seek health care facilities somewhere else leading to DAMA. Further analysis of these factors would have been very insightful for the readers. Such findings would also help guide health care entities to adopt a holistic approach toward reducing DAMA and improving the health outcomes.

Abstract 11793: Rates and Causes of Readmission in Patients With Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis of 17,860 Index Hospitalizations

Background: The risk of fatal and recurrent cardiovascular complications in Hypertrophic Cardiomyopathy (HCM) warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index HCM admissions. Methods: PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through May 2022 reporting rates and causes of readmission following index HCM admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I 2 statistics were used to report inter-study heterogeneity. Results: This meta-analysis included 17860 index HCM admissions (Mean age: 46-67 years, median follow up duration: 321.6 days, Female 53.11%) from 17 studies, which revealed a 14.8% [95% CI 12.2%-17.4%, I 2 =96%] pooled rate of readmission (Fig. 1) . Studies published from China (23.5% vs. 10.5%) had a higher readmission rate than the USA (Fig. 2) . The long-term readmission rate was highest within 1-3 years (26.6%) and in patients who underwent alcohol septal ablation procedure (10% vs 7.6%) compared to those who underwent surgical myectomy (Fig. 3) . The readmission rate was higher in cohorts with smaller sample sizes (19.2% vs 10.2%) (n&lt;1000 vs. n&gt;1000). Among the readmission events, congestive heart failure, and acute decompensated heart failure were the leading causes of readmission, accounting for up to 66% of the readmission cases [95%CI 32.5%-100.4%, p&lt;0.001] following index admissions. Conclusions: In this global meta-analysis, the pooled rate of readmission following index HCM hospitalizations was nearly 15% over a year's follow-up, with heart failure accounting for two-thirds of the readmissions.

Abstract 15895: Causes and Predictors of 30-Day Readmission After Implantable Cardioverter/Defibrillator Insertion in Heart Failure Patients: Insight From the National Readmissions Database

Introduction: Implantable Cardioverter/Defibrillator (ICD) insertion in heart failure (HF) patients with ejection fraction below 30% and at least 40 days post-infarction is rapidly becoming commonplace. Given the high prevalence of ICD insertions in HF patients with reduced ejection fraction (HFrEF) we aimed to analyze the rates and causes of readmissions in this specific population. Methods: We utilized the National Readmission Database from 2018 to identify hospitalized adults with HF who underwent ICD insertion. We included those who were readmitted within 30 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission. Results: During the study period, 283,539 hospitalized patients with HF who underwent ICD insertion were discharged alive. Within 30-days from discharge, 46,537 (16.4%) were readmitted. The top three causes of readmission were heart failure (35.2%), sepsis (5.26%), and ventricular tachycardia (4%). Readmitted patients were more likely to be discharged to nursing facility (45% vs 38%; p&lt;0.001), had higher rates of Medicare/Medicaid (89.2% vs 78.7%; p&lt;0.001) and annual income &lt; $44,000 (35.7% vs 33%; p&lt;0.001). In-hospital mortality (5.6% vs 3.4%; p&lt;0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Conclusions: We identified social and clinical predictors of readmission after ICD insertion in those with HF such as household income, discharge to a nursing home, renal/lung disease, and intubation during their index admission. Healthcare systems should use this data to target modifiable factors to prevent readmissions as this can help ease the burden placed on the resources of the American healthcare system and improve clinical outcomes for patients.

Abstract 15115: Causes and Predictors of 90-Day Readmission Among Patients Admitted With Acute Myocarditis

Introduction: Myocarditis contributes to the global burden of cardiovascular disease primarily through sudden death and dilated cardiomyopathy. We aimed to study patient characteristics, national readmission rates and predictors for patients admitted for acute myocarditis utilizing a nationally representative cohort of patients from the National Readmission Database. Methods: We utilized the National Readmission Database 2018 to identify the hospitalized adults with a primary diagnosis of acute myocarditis. We included subjects who were readmitted within 90 days after index admission. We excluded subjects with elective and traumatic admissions. We utilized a multivariate cox regression model to identify independent predictors of readmission. Results: During the study period, 3,524 hospitalized patients who had a primary diagnosis of acute myocarditis were discharged alive. Within 90 days of discharge, 356 (10.1%) subjects were readmitted. The top three causes of readmission were heart failure (37.1%), sepsis (16.1%) and ventricular tachycardia (10.6%). The in-hospital mortality rate (5.5 vs. 2.6%, p&lt;0.001) was significantly higher during readmission. There was a trend in higher length of stay in readmission (5.6 vs. 4.3 days, p=0.055), however this difference was not statistically significant. Figure 1 shows the Forest plot of multivariate analysis of independent factors associated with readmissions. Conclusion: Our study identified significant factors such as heart failure, atrial fibrillation, hypertension related to higher readmission odds for myocarditis patients. This data may contribute to the healthcare system to help modify strategies to minimize readmission.

Abstract 14034: 30-day Readmission Rates of Cardiogenic Shock: A Nationwide Analysis of Inpatient Demographics and Clinical Outcomes

Introduction Cardiogenic shock (CS) is a common medical emergency that causes significant morbidity and mortality. Our aim was to characterize patient demographics and analyze the factors that increase the likelihood for CS readmissions. Methods This was a retrospective cohort study using the 2019 Nationwide Readmissions Database (NRD) database to identify admissions in adults with principal diagnosis of CS. Results The index CS admission cohort was 62.2% males, mean age 66.9 years. Of 146,254 index admissions with CS, 19,238 (20.4%) were readmitted. 30-day mortality rate (MR) of index admission was 35.4%, with a MR of 9.7% in those readmitted. The most common cause for readmissions was acute heart failure (26.7%). Patients with the lowest median household income, Medicare, and Medicaid insurance were more likely to be readmitted (1.10 OR 95% CI 1.04 -1.16, p &lt;0.01, 1.17 OR 95% CI 1.11-1.24, p &lt;0.001 and 1.27 OR 95% CI 1.12-1.86, p &lt;0.001 respectively). Meanwhile, being in the highest median household income quartile (&gt;75 th ) or having private insurance were protective against readmission. Acute MI patients were less likely to be readmitted (0.83 OR 95% CI 0.79 -0.87, p &lt;0.001). Diastolic HF and CHF were associated with increased odds of readmission when adjusted for other comorbidities, age, and gender (2.52 OR 95% CI 1.09-5.83, p&lt;0.031 and 2.15 OR 95% CI 1.01-4.57, p&lt;0.046 respectively). Conclusion Readmission after CS is common, with high mortality. Risk factors for readmission include lower household income and Medicare/Medicaid insurance, and those that leave AMA after index cardiogenic shock admission have increased odds of readmission. Conversely, those with the highest median household income and with private insurance had a significantly lower rate of readmission. Additional research is needed to elucidate the contributing factors for this stark difference.