Cause Of 30-day Readmissions Research Articles

Index Admission and Thirty-Day Readmission Outcomes of Patients With Cancer Presenting With STEMI

BackgroundNational-level data of cancer patients' readmissions after ST-segment elevation myocardial infarction (STEMI) are lacking. ObjectivesThe primary aim of this study was to compare the rates and causes of 30-day readmissions in patients with and without cancer. MethodsAmong patients admitted with STEMI in the United States National Readmission Database (NRD) from October 2015–December 2017, we identified patients with the diagnosis of active breast, colorectal, lung, or prostate cancer. The primary endpoint was the 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of patients with and without cancer. ResultsA total of 385,522 patients were included in the analysis: 5956 with cancer and 379,566 without cancer. After propensity score matching, 23,880 patients were compared (Cancer = 5949, No Cancer = 17,931). Patients with cancer had higher 30-day readmission rates (19% vs. 14%, p < 0.01). The most common causes for readmission among patients with cancer were cardiac (31%), infectious (21%), oncologic (17%), respiratory (4%), stroke (4%), and renal (3%). During the first readmission, patients with cancer had higher adjusted rates of in-hospital mortality (15% vs. 7%; p < 0.01) and bleeding complications (31% vs. 21%; p < 0.01), compared to the non-cancer group. In addition, cancer (OR 1.5, 95% CI 1.2–1.6, p < 0.01) was an independent predictor for 30-day readmission. ConclusionsAbout one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cardiac causes predominated the reason for 30-day readmissions in patients with cancer.

Risk factors, causes, and rates associated with hospital readmission after pediatric neck mass surgery

BackgroundTo understand rates, risk factors, and costs associated with hospital readmission in pediatric patients who underwent neck mass excision. MethodsThis was a retrospective review of the Nationwide Readmissions Database (NRD) between 2010 and 2014 of select neck mass procedures, defined as affecting the following: thyroid, salivary gland, cervical lymph nodes, branchial cleft, thymus, and head and neck vessels. We analyzed rates and causes of 30-day readmissions using univariate and multivariate logistic regression. ResultsThere were a total of 11,824 weighted cases identified with a 30-day readmission rate of 9.0% and a mean age of 9.5 years old. The sex distribution of patients undergoing neck mass procedures was 55.8% female and 44.2% male. The most common cause of readmission was associated with a comorbid condition likely unrelated to the neck mass procedure (53%). The most common procedure-related readmission causes were associated with a postoperative neck mass (14.4%), wound (13%), and infection (6.5%). In the multivariate model, number of procedures≥5 (OR: 2.11, 95% CI: 1.28–3.49), number of chronic conditions≥1 (OR: 2.33, 95% CI: 1.16–4.66), length of hospital stay of≥7 days (OR: 2.43, 95% CI: 1.48–0.3.98), and cervical lymph node procedure (OR:2.61, 95% CI: 1.47–4.63) were associated with higher readmission risk. ConclusionReadmission after surgery for pediatric neck masses is relatively common, with an average of 9.0%. Risk factors associated with readmission include length of initial hospital stay, number of chronic conditions, number of procedures performed, and undergoing a cervical lymph node procedure.

Abstract 15368: Index Admission and Thirty-day Readmission Outcomes of Cancer Patients Presenting With Stemi

Introduction: National-level data of cancer patients’ readmissions after a ST-segment elevation myocardial infarction (STEMI) are lacking. Objectives: The primary aim of this study was to describe rates and causes of 30-day readmissions in this population. Methods: Among patients who were admitted with STEMI in the United States National Readmission Database (NRD) from October 2015-December 2017, we identified patients with the diagnosis of active breast, colorectal, lung or prostate cancer. The primary endpoint was 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of cancer and no cancer patients. Results: A total of 385,522 patients were included in the current analysis (Cancer= 5,956, No Cancer=379,566). After propensity score matching, 23,880 patients were compared (Cancer=5,949, No Cancer=17,931). Cancer patients had higher 30-day readmission (19% vs 14%, p&lt;0.01). The most common causes for readmission among cancer patients were cardiac (31%), followed by infectious (21%), hematological and oncological (17%), respiratory (4%), stroke (4%) and renal (3%). During the first readmission, cancer patients had higher in-hospital mortality (15% vs 7%; p&lt;0.01) and bleeding complications (31% vs 21%; p&lt;0.01). In multivariate logistic regression, cancer status (OR 1.5, 95% CI 1.2-1.6, p&lt;0.01) was an independent predictor for 30-day readmission. Conclusions: About one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cancer patients’ 30-day readmissions are still predominantly cardiac-related but with a higher proportion of admissions for infectious, cancer-related and bleeding and than those without cancer.

Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States

Abstract Background Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure. Purpose The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States. Methods The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups. Results The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p&amp;lt;0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure). Conclusions In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia. Causes of readmission Funding Acknowledgement Type of funding source: None

CT FINDINGS IN 30-DAY COPD READMISSIONS

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The course of chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, is characterized by exacerbations. Recurrent exacerbations are currently the third leading cause of 30-day readmissions among Medicare patients with substantial cost burden. Computed tomography (CT) imaging has been used in defining phenotypes in COPD with poor clinical outcomes. However, CT findings in patients readmitted within 30 days of an acute exacerbation have not been well characterized. The purpose of this study was to determine whether any specific CT findings in this population could influence management of acute exacerbations of COPD. METHODS: This was a single center, retrospective study conducted in a university hospital with local IRB approval. CT scan findings in patients with COPD readmitted within 30-days of a hospitalization between December 2017 and November 2019 were evaluated. We included patients who had a chest CT performed on their readmission as part of routine care. Descriptive statistics were used to analyze the data. RESULTS: We included 84 patients (mean age 66±9.8 years). Of these, 47 (55%) were males and 41 (49%) were current smokers. The average length of time out of the hospital was 15.2±8.3 days. There were 71 patients with a principal admitting diagnosis of COPD exacerbation or pneumonia. The predominant CT findings were airspace consolidation (46%), emphysema (46%), mucus plugging/retained airway secretions (30%), mediastinal/hilar adenopathy (30%), pulmonary nodules (28%) and bronchial wall thickening (26%). An increased pulmonary artery diameter, suggesting pulmonary hypertension, was noted in 18 (25%) patients. CT pulmonary angiograms were performed in thirty-seven (52%) studies with pulmonary emboli detected in only 3 patients. CONCLUSIONS: CT findings in 30-day COPD readmissions are widely varied. However, airspace consolidations, emphysema, retained airway secretions and enlargement of the pulmonary arteries were common findings. Contrary to popular belief, prevalence of pulmonary embolism was low in our patients. CLINICAL IMPLICATIONS: Focusing on airway clearance therapies could be beneficial in the management of patients with acute exacerbations of COPD. DISCLOSURES: No relevant relationships by Isaac Biney, source=Web Response Advisory Committee Member relationship with Boehringer-Ingelheim Please note: $5001 - $20000 Added 07/18/2020 by Rajiv Dhand, source=Web Response, value=Consulting fee Advisory Committee Member relationship with GSK Please note: $1001 - $5000 Added 07/18/2020 by Rajiv Dhand, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Mylan Please note: $1001 - $5000 Added 07/18/2020 by Rajiv Dhand, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Teva Please note: $1001 - $5000 Added 07/18/2020 by Rajiv Dhand, source=Web Response, value=Consulting Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 07/18/2020 by Rajiv Dhand, source=Web Response, value=Consulting fee No relevant relationships by Tina Dudney, source=Web Response No relevant relationships by Jennifer Ferris, source=Web Response no disclosure on file for Jeffrey Peeke; no disclosure on file for James Shamiyeh

Predictors, causes and outcome of 30-day readmission among acute ischemic stroke

ABSTRACT Background and Purpose Readmission within 30 days of index acute ischemic stroke (AIS) after hospitalization increases the burden on patients and healthcare expense. The purpose of our study was to investigate predictors and causes of 30-day readmission after AIS and investigate hospitalization expenses, length of stay (LOS) and in-hospital mortality of 30-day readmission. Methods This is a multicenter retrospective study. AIS were captured by International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes, patients with readmitted within 30 days after discharge were identified as readmission group. Multivariable logistic regression was used to identify independent predictors of 30-day readmissions. Hospitalization expenses, LOS and in-hospital mortality were compared for index admission and readmission. Results We identified 2371 patients with AIS, 176 patients died before discharge, 504(23.0%) patients were admitted within 30 days. Older age, prior stroke, non-neurology floor during index admission, indwelling urinary catheter and diabetes were independently associated with increased risk of 30-day readmission (P<0.05). The most common causes for 30-day readmission were infection (28.8%) and recurrent stroke and TIA (22.8%). Patients with 30-day readmission have longer LOS and higher hospitalization expenses on readmission compared with the mean of these metrics on index admission (P<0.001). The in-hospital mortality after a within 30-day readmission was higher than index admission (13.1% vs 8.0%; OR 1.88, 95% CI 2.5–5.3; P<0.001). Conclusions Older age, stroke severity, prior stroke, diabetes, indwelling urinary catheter and admission to non-neurology floor during index admission were associated with 30-day readmission. 30-readmission after AIS increased hospitalization expenses, LOS and in-hospital mortality.

Thirty-day readmissions after atrial fibrillation catheter ablation in patients with heart failure.

Randomized clinical trial data have demonstrated catheter ablation (CA) as a viable treatment modality for atrial fibrillation (AF). Patients with heart failure (HF) undergoing AF CA appear to derive improvements in quality of life and mortality compared to those treated with medical therapy (MT). Contemporary national data on 30-day readmissions after CA compared to MT among patients with HF are lacking. From the 2016 Nationwide Readmissions Databases, 749776 (weighted national estimate: 1421673) AF HF patients were identified of which 2204 (0.3%) underwent CA and 747572 (99.7%) received MT. Propensity matching balanced baseline clinical characteristics. Thirty-day readmission rates, causes, predictors, and costs of 30-day readmission were compared. Among both the unmatched and matched cohorts, 30-day readmissions were lower for patients treated with CA compared to MT (16.8%vs 20.1%, P<.001 and 16.8%vs 18.8%, P=.020). CA was associated with reduced risk of readmission compared to MT (odds ratio 0.86, 95% confidence interval [CI]: 0.77-0.97). HF exacerbation and arrhythmias were the most common cause for 30-day readmission after CA. CA costs were higher during index hospitalization but similar to MT during readmission among the matched cohort ($15858 ± $21636vs $16505 ± $29171, P=.67). Predictors of readmission were largely nonmodifiable risk factors among both the CA and MT groups. Nearly one in six patients with HF is readmitted within 30-days after undergoing CA. In propensity matched analyses, CA was associated with decreased rate and risk for readmission compared to MT. CA has higher index hospitalization costs, but lower readmission costs.

Short-term outcomes associated with inpatient ventricular tachycardia catheter ablation.

Utilization of catheter ablation of ventricular tachycardia (VT) has steadily increased in recent years. Exploring short-term outcomes is vital in health care planning and resource allocation. The Nationwide Readmissions Database from 2010 to 2014 was queried using the ICD-9 codes for VT (427.1) and catheter ablation (37.34) to identify study population. Incidence, causes of 30-day readmission, in-hospital complications as well as predictors of 30-day readmissions, complications, and cost of care were analyzed. Among 11725 patients who survived to discharge after index admission for VT ablation, 1911 (16.3%) were readmitted within 30 days. Paroxysmal VT was the most common cause of 30-day readmission (39.51%). Dyslipidemia, chronic kidney disease (CKD), previous CABG, congestive heart failure (CHF), chronic pulmonary disease, and anemia predicted increased risk of 30-day readmissions. The overall in-hospital complication rate was 8.2% with vascular and cardiac complications being the most common. Co-existing CKD and CHF and the need for mechanical circulatory support (MCS) predicted higher complication rates. Similarly increasing age, CKD, CHF, anemia, in-hospital use of MCS or left heart catheterization, teaching hospital, and disposition to nursing facilities predicted higher cost. Approximately one in six patients was readmitted after VT ablation, with paroxysmal VT being the most common cause of the readmission. A complication rate of 8.2% was noted. We also identified a predictive model for increased risk of readmission, complication, and factors influencing the cost of care that can be utilized to improve the outcomes related to VT ablation.

Erratum. Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke.

Objective The 30-day readmission rate is of increasing interest to hospital administrators and physicians, as it is used to evaluate hospital performance and is associated with increased healthcare expenditures. The estimated yearly cost to Medicare of readmissions is $17.4 billion. The Centers for Medicare and Medicaid Services therefore track unplanned 30-day readmissions and institute penalties against hospitals whose readmission rates exceed disease-specific national standards. One of the most important conditions with potential for improvement in cost-effective care is ischemic stroke, which affects 795,000 people in the United States and is a leading cause of death and disability. Recent widespread adoption of mechanical thrombectomy has revolutionized stroke care, requiring reassessment of readmission causes and costs in this population. Methods The authors retrospectively analyzed a prospectively maintained database of stroke patients and identified 561 patients who underwent mechanical thrombectomy between 2010 and 2019 at the authors' institution. Univariate and multivariate analyses were conducted to identify clinical variables and comorbidities related to 30-day readmissions in this patient population. Results Of the 561 patients, 85.6% (n = 480) survived their admission and were discharged from the hospital to home or rehabilitation, and 8.8% (n = 42/480) were readmitted within 30 days. The median time to readmission was 10.5 days (IQR 6.0-14.3). The most common reasons for readmission were infection (33.3%) and acute cardiac or cerebrovascular events (19% and 20%, respectively). Multivariate analysis showed that hypertension (p = 0.030; OR 2.72) and length of initial hospital stay (p = 0.040; OR 1.032) were significantly correlated with readmission within 30 days, while hemorrhagic conversion (grades 3 and 4) approached significance (p = 0.053; OR 2.23). Other factors, such as unfavorable outcome at discharge, history of coronary artery disease, and discharge destination, did not predict readmission. Conclusions The study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions.

Readmissions Are Not What They Seem: Incidence and Classification of 30-Day Readmissions After Orthopedic Trauma Surgery.

To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission. Retrospective chart review. One large, academic, medical center. Patients admitted to a large, academic, medical center for a traumatic fracture injury over a 9-year period. Assignment of readmission classification. Readmissions within 30 days of discharge were identified and classified into orthopedic complications, medical complications, and noncomplications. A χ test was performed to assess any difference in the proportion of readmissions between the hospital-reported readmission rate and the orthopedic complication readmission rate. One thousand nine hundred fifty-five patients who were admitted between 2011 and 2018 for an acute orthopedic trauma fracture injury were identified. Eighty-nine patients were readmitted within 30 days of discharge with an overall readmission rate of 4.55%. Within the 30-day readmission cohort, 30 (33.7%) were the direct result of orthopedic treatment complications, 36 (40.4%) were unrelated medical conditions, and 23 (25.8%) were noncomplications. Thus, the readmission rate directly due to orthopedic treatment complications was 1.53%. A χ test of homogeneity revealed a statistically significant difference between the hospital-reported readmission rate and the orthopedic-treatment complication readmission rate (P < 0.0005). The use of 30-day readmissions as a measure of hospital quality of care overreports the number of preventable readmissions and penalizes surgeons and hospitals for caring for patients with less optimal health. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases

BackgroundPulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases.MethodsThis was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged ≥65 years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors.ResultsFor bronchitis and asthma, male patients had significantly higher odds of 30-day readmission than female patients (adjusted odds ratio (aOR), 2.07; 95% confidence interval (CI), 1.11–3.87). The odds of readmission for men were also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13–1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05–1.55), and for COPD (aOR, 1.34; 95% CI, 1.00–1.81).ConclusionsThis study found that male sex is a major risk factors for readmission in patients aged more than 65 years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions.

Sex differences in rates and causes of 30-day readmissions after cardiac electronic device implantations: insights from the Nationwide Readmissions Database

BackgroundWomen undergoing cardiac implantable electronic device (CIED) implantation are at a higher risk of procedure-related complications. The present study examined sex differences in rates and causes of 30-day readmissions following CIED implantation. MethodsUsing the United States Nationwide Readmissions Database (NRD), all adults who had undergone CIED implantation (cardiac resynchronization therapy (CRT), permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD)) between January 2010 and September 2015 were included. We compared rates, trends and causes of 30-day readmissions between sexes, and examined associations between sex and outcomes (adjusted odds ratios (aOR) and 95% confidence intervals (CI)). ResultsOut of 1,155,992 index hospitalizations for CIED implantation, 43.1% of the patients were women. All-cause 30-day readmissions were persistently higher in women than men but declined in both sexes over the study period, more so in women (women vs. men; 2010: 15.0% vs. 14.1%; 2015: 13.7% vs.13.4%). Women were at higher odds of readmission due to cardiac (aOR 1.22, 95%CI 1.20–1.24) and device-related complications (aOR 1.18, 95%CI 1.15–1.20) compared to men, but no difference odds of all-cause readmission were found between sexes (women: aOR 0.998, 95%CI 0.997–1.008). The most common cardiac and non-cardiac causes of readmission were heart failure and infection, respectively, and these were similar in both sexes (men vs. women: 17.8% vs. 17.6% and 10.7% vs. 10.8%, respectively). ConclusionWomen are persistently at higher risk of readmission due to cardiac causes and device-related complications compared to men over a six-year period, but no difference in all-cause readmissions was found between sexes.

Abstract 113: Readmission Rates and Causes for In-Hospital Cardiac Arrest Survivors at 30 and 180 Days: Insights from Nationwide Readmission Database

Introduction: Rates of survival to discharge for patients with in-hospital cardiac arrest (IHCA) have improved over the past 2 decades from 13% in 2000 to 25% in 2016. Yet, little is known about rates and causes of readmissions among those survivors. We sought to investigate early and late rates and causes of readmission for IHCA survivors at 30 and 180 days after discharge. Methods: Within the Nationwide Readmission Database (NRD), we identified patients 18 years of age or older who survived to hospital discharge after an IHCA between 2010 and 2016. IHCA was defined by an ICD-9 or ICD-10 diagnosis code (cardiac arrest, ventricular fibrillation or flutter) combined with a procedure code (defibrillation or external chest compression). We evaluated rates and causes of 30 and 180 days readmission and examined whether these have changed over time. Results: A total of 86,140 patients had an IHCA and survived to hospital discharge. Overall, mean age was 64.3 ± 14.9, women were 40.1%, and the mean length of stay was 15.1 ±17.9 days. All-cause readmission rates at 30 and 180 days were 22.7% and 69.9%, respectively. Readmission rates decreased over time. Thirty-day readmission rates decreased from 23.8% in 2010 to 21.1% in 2016, and 180-day readmission rates decreased from 76.1% to 63.6%. (Figure) Among readmitted patients, 13.5% were readmitted more than once at 30 days and 44.9% were readmitted more than once at 180 days. The most common cause of 30-day readmissions were congestive heart failure (11.7%), infection/septicemia (11.4%), and cardiac dysrhythmias (5.3%),whereas the top causes of 180-day readmissions were congestive heart failure (11.9%), infection/septicemia (11.3%), and respiratory insufficiency, or device complications (4.6%). Conclusion: All-cause readmission rates for IHCA survivors at 30 and 180 days have decreased over time, Congestive heart failure is the most common cause of readmissions but accounts for only 11.7% and 11.9% of readmissions at 30 and 180 days.

Thirty-Day Readmissions After Upper and Lower Gastrointestinal Hemorrhage: A National Perspective in the United States.

Upper gastrointestinal hemorrhage (UGIH) and lower gastrointestinal hemorrhage (LGIH) are 2 of the most common reasons for hospital admissions across the United States. The 30-day readmission after index admission poses a major burden on the health care infrastructure, and thus, it is important to assess the causes of 30-day readmission for patients with UGIH and LGIH. The study cohort was derived from the 2013 National Readmission Database. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volume 3 diagnosis codes were utilized to identify UGIH and LGIH patients from this data set. Patients who were readmitted to the hospital within 30 days within the same calendar year were further analyzed. Categorical variables and continuous variables were assessed by the χ test and the student t test, respectively. The independent predictors of unplanned 30-day readmissions were recognized by multivariate logistic regression, adjusting for stratified cluster design of National Readmission Database. SAS 9.4 (SAS Institute Inc., Cary, NC) was used for data analysis. The number of index admissions identified from the National Readmission Data 2013 were 82,290 for UGIH and 133,114 for LGIH. All-cause 30-day readmission rate for UGIH versus LGIH was 14.6% (readmitted N=12,046; 56.64% age 65 y and above) versus 14.4% (readmitted N=19,128; 70.21% age 65 y and above and 49.61% men). Gastrointestinal causes were most common (33.9% vs. 39.6%), followed by cardiac (13.3% vs. 15.3%), infectious (10.4% vs. 9.1%), and respiratory causes (7.8% vs. 7.1%) for 30-day readmission for UGIH and LGIH. Significant predictors of increased 30-day readmission (odds ratio, 95% confidence interval, P-value) included metastatic disease (2.15, 1.75-2.64, P<0.001), discharge against medical advice (1.85, 1.55-2.22, P<0.001), and length of stay >3 days (1.50, 1.38-1.63, P<0.001). Predictors for 30-day readmission for LGIH included metastatic disease (1.75, 1.48-2.06, P<0.001), liver disease (1.59, 1.49-1.71, P<0.001), and drug abuse (1.38, 1.21-1.58, P<0.001). Most common reason for UGIH and LGIH readmission was related to gastrointestinal disease, followed by cardiac, infectious, and respiratory etiologies. By addressing these etiologies for readmission, it may be possible to reduce adverse outcomes.

Specific Causes of 30-Day and 1-Year Readmissions in Heart Failure Patients

Background Readmission rates are a major metric used in evaluating the quality of hospital care for heart failure patients, but the specific causes of readmission are uncertain. Much of the existing data focuses on all-cause readmissions or uses ICD classification coding to determine causes for readmission. In this study, we retrospectively review heart failure cases to identify the specific causes of 30-day and 1-year readmission. Methods We identified heart failure patients from the University of Maryland Medical Center with an index hospitalization between January 2017 - March 2017. All charts were reviewed to determine if the index hospitalization was for heart failure. The charts were then reviewed to determine causes of subsequent readmissions. 30-day and 1-year readmissions were recorded. Readmissions were categorized as due to heart failure exacerbation, other cardiac causes, non-cardiac chest pain, infections, GI disorders, neurological disorders, renal disorders, pulmonary disorders, or trauma and surgical conditions. Planned readmissions were excluded. Results A total of 232 patients were identified to have an index heart failure hospitalization in the specified time frame. 21% of patients were readmitted within 30 days. Heart failure exacerbation, other cardiac causes, and infections were the leading causes of 30-day readmission, representing 53%, 16%, and 14% of 30-day readmissions respectively. 53% of the cohort had at least 1 readmission over 1 year. There was a total of 330 readmissions over 1 year. Heart failure exacerbation, infections, and non-cardiac chest pain were the leading causes of 1-year readmission, representing 40%, 16%, and 8% of 1-year readmissions. Discussion Heart failure exacerbation was the leading cause of both 30-day and 1-year readmissions, but infections, other cardiac causes, and non-cardiac chest pain were also significant contributors to readmissions after an index heart failure hospitalization. Prevention of readmissions necessitates addressing non-cardiac causes as well as heart failure status.

Predictors of Cost and Incidence of 30-Day Readmissions Following Hospitalizations for Schizophrenia and Psychotic Disorders: A Nationwide Analysis.

Schizophrenia and psychotic disorders (SPDs)-related hospitalizations are the second leading cause of 30-day readmission. This study assessed the effect of patient and hospital-level factors on readmission costs following index hospital discharges for SPDs. 2014 Nationwide Readmissions Database was used to identify SPD-related discharges between January 1, 2014, and November 30, 2014. Multivariable logistic regression was used to estimate patient and hospital-level predictors for readmissions. A two part model was used to estimate the predictors of readmission and associated cost for index hospital discharges with SPDs. A total of 77 625 of 343 579 (22%) index hospital discharges for SPDs resulted in readmissions. The average index and readmission costs were $9285 and $8593, respectively. Being 25 to 44 years old (odds ratio: 1.14), with nonmental comorbidities (odds ratio: 1.52), and admitted in private hospitals (odds ratio: 1.24) had significantly higher odds of readmission rates. Being males ($105), 25 to 44 years of age ($99), urban residents ($312), Medicare enrollees ($713 over privately insured), high-income area residents ($393), having multiple comorbidities ($923), and those admitted in large metropolitan ($680) and government-owned hospitals ($417) had higher costs of readmission. The high SPD-related readmission rates can be reduced by providing integrated behavioral health services for this high-risk cohort.

Predictors and Costs of 30-Day Readmissions After Index Hospitalizations for Alcohol-Related Disorders in U.S. Adults.

In 2015, the Hospital Readmissions Reduction Program mandated financial penalties to hospitals with greater rates of readmissions for certain conditions. Alcohol-related disorders (ARD) are the fourth leading cause of 30-day readmissions. Yet, there is a dearth of national-level research to identify high-risk patient populations and predictors of 30-day readmission. This study examined patient- and hospital-level predictors for index hospitalizations with principal diagnosis of ARD and predicted the cost of 30-day readmissions. The 2014 Nationwide Readmissions Database was used to identify ARD-related index hospitalizations. Multivariable logistic regression was used to estimate patient- and hospital-level predictors for readmissions, and a 2-part model was used to predict the incremental cost conditional upon readmission. In 2014, 285,767 index hospitalizations for ARD were recorded, and 18.9% of ARD-associated hospitalizations resulted in at least one 30-day readmission. Patients who were males, aged 45 to 64years, Medicaid enrollees, living in urban and low-income areas, or with 1 to 2 comorbidities had high risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, p<0.01). Predicted mean costs for readmissions on index stay with ARD were greater among those aged 45 to 64years ($1,908, p<0.001), Medicare enrollees ($2,133, p<0.001), rural residents ($1,841, p<0.01), living in high-income areas ($1,876, p<0.001), with 4 or more comorbidities ($2,415, p<0.001), or admitted in large metropolitan hospitals ($2,032, p<0.001), with large number of beds ($1,964, p<0.001), with government ownership ($2,109, p<0.001), or with low volume of ARD cases ($2,155, p<0.001). One in 5 ARD-related index hospitalizations resulted in a 30-day readmission. Overall, costs of index hospitalizations for ARD were $2.3 billion, of which $512 million were spent on hospitalizations that resulted in at least 1 readmission. There is a need to develop patient-centric health programs to reduce readmission rates and costs among ARD patients.

Association of Surgical and Hospital Volume and Patient Characteristics With 30-Day Readmission Rates

Thirty-day readmission rates have been suggested as a marker for quality of care. By investigating the factors associated with readmissions in all otolaryngology subspecialties we provide data relevant for the development of risk stratification systems to improve outcomes. To establish the association of surgical and hospital volume and patient characteristics with 30-day readmission rates to guide the development of otolaryngology-specific risk stratification models. A retrospective cohort study including adult patients who underwent inpatient otolaryngology surgery in New York State between 1995 and 2015 was conducted using the Statewide Planning and Research Cooperative System (SPARCS). Regression techniques were used to describe relationships of patient-level factors, hospital, and surgeon volume to 30-day readmission rates in New York State. The main outcome measures were patient-, surgeon-, and hospital-level risk factors for readmission. Secondary outcome measures were rate of readmissions by subspecialty procedure and by diagnosis on readmission. We identified 254 257 cases of otolaryngology surgery (147 065 women [58%], mean [SD] age 50 [17] years). The 30-day readmission rate was 6%. In a multivariable model, odds ratios (ORs) identified Medicaid insurance (OR, 1.46; 99% CI, 1.36-1.57), Medicare insurance (OR, 1.32; 99% CI, 1.24-1.42), bottom quartile income (OR, 1.08; 99% CI, 1.01-1.15), patient comorbidities measured by the Charlson Comorbidity Index (CCI) (CCI >1; OR, 2.31; 99% CI, 2.16-2.47), length of stay (LOS) (LOS >10 days; OR, 2.29; 99% CI, 2.00-2.45), rhinology (OR, 1.37; 99% CI, 1.24-1.51), laryngology (OR, 1.98; 99% CI, 1.62-2.43), and head and neck cancer (OR, 1.27; 99% CI, 1.17-1.37) procedures as readmission predictors. High-volume surgeons were protective of 30-day readmission (OR, 0.67; 99% CI, 0.635-0.708) relative to low volume. Hospital volume was not significantly associated to readmissions. The most common causes of readmission included wound- (2682 patients, 18%), respiratory- (1776 patients, 12%), cardiovascular- (1210 patients, 8%), and volume- (1089 patients, 7%) related disorders. This study evaluated the combined effects of patient-, surgeon-, and hospital-level factors on 30-day readmission after otolaryngology surgery. Socioeconomic factors, patient comorbidities, surgeon volumes, and procedure were significantly associated with 30-day readmission. Though the cause of 30-day readmission is multifactorial, a large portion is driven by socioeconomic factors. Addressing these disparities at the system level is necessary to address the described readmission disparities. The development of risk-stratification models based on patient-, procedure-, and surgeon-level factors may help facilitate resource distribution.

Epidemiology and Predictors of 30-Day Readmission in Patients With Sepsis

Patients with sepsis are particularly vulnerable to readmissions. We describe the associated etiology and risk factors for readmission in patients with sepsis using a large administrative database inclusive of patients of all ages and insurance status. Our study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data from 2013 to 2014 by identifying patients admitted with sepsis. The primary outcome was 30-day readmission with etiology identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes. From a total 1,030,335 index admissions; mean age, 66.8 ± 17.4 years (60%age≥65 years), 898,257 patients (87.2%) survived to discharge. A total of 157,235 (17.5%) patients had a 30-day readmission; median time to readmission was 11days (interquartile range, 5-19). Infectious etiology (42.16%; including sepsis, 22.86%) was the most commonly associated cause for 30-day readmission followed by gastrointestinal (9.6%), cardiovascular (8.73%), pulmonary (7.82%), and renal causes (4.99%). Significant predictors associated with increased 30-day readmission included diabetes (OR, 1.07; 95%CI, 1.06-1.08; P< .001), chronic kidney disease (1.12;1.10-1.14, P< .001), congestive heart failure (OR, 1.16; 95%CI, 1.14-1.18; P< .001), discharge to short-/long-term facility (OR, 1.13; 95%CI, 1.11-1.14; P< .001), Charlson comorbidity index≥ 2, and length of stay≥ 3days during the index admission. The mean cost per readmission was $16,852; annual cost was > $3.5 billion within the United States. We describe that readmission after a sepsis hospitalization is common and costly. The majority of readmissions were associated with infectious etiologies. The striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this outcome.

Risk of readmission for infection after surgical intervention for intracerebral hemorrhage

BackgroundSeveral operative interventions are performed to reduce the mortality and morbidity of Intracerebral hemorrhage (ICH) in the acute setting, including: craniotomy or craniectomy, placement of an external ventricular drain (EVD), placement of a ventriculo-peritoneal shunt (VPS) and stereotactic craniotomy. Infections are a major source of readmissions following ICH. We explored the association between operative interventions for ICH and 30-day readmissions for infection-related causes. MethodsThe Nationwide Readmissions Database contains >14 million discharges for all payers and uninsured in 2013. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify index cases of ICH, intracranial procedures, and comorbidities. We summarized demographics and comorbidities during index admission, stratified by receipt of operative interventions. We calculated differences in means (using t-tests) and frequencies (using chi-square) by group (any intervention versus none). Top 5 causes of 30-day readmission and top 5 causes for infectious readmissions were identified. Cox regression analysis was performed for time to readmission for infectious causes. ResultsThere were 27,739 index admissions with ICH, 13% had operative interventions. In the operative group, 45.5% underwent craniotomy, 65.4% had EVD placement and 7.6% had VPS placement. Acute cerebrovascular disease was the top cause of readmission followed by infection in the entire cohort and those with interventions. Among infectious causes of readmissions, septicemia was the largest in the intervention group (65%). In both adjusted and unadjusted models, there was significant association between ICH intervention and risk of readmission for infectious causes. Among those with operative interventions for ICH, risk of readmission with infection is double the risk in the non-intervention group. Cumulative risk of readmission was higher for infection following ICH, starting after approximately 50 days, in the intervention group (log-rank p-value <.0001). ConclusionsInfections and cerebrovascular complications contribute to most readmissions after ICH. There is a dose-response relationship between number of interventions and risk of infectious readmission, and this risk significantly increases after approximately 50-days.