Common Reasons For Readmission Research Articles

Abstract 4145842: The Incidence, Predictors and Impact of 30-day Readmission of Takotsubo Cardiomyopathy Hospitalization: A Retrospective Nationwide Analysis

Objective: This study aimed to describe the recent readmission and mortality rates of unplanned 30-day all cause readmission after takotsubo cardiomyopathy hospitalization. Methods: We conducted an analysis of the 2020 Nationwide Readmission Database. Using the ICD-10 code, we identified hospitalizations for takotsubo cardiomyopathy. We excluded hospitalizations for age<18years and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, Pearson χ2 tests were employed. We utilized multivariate Cox regression analyses to identify independent predictors of readmissions. Results: A total of 7554 patients were hospitalized for index admission for takotsubo cardiomyopathy, and 633 of them were readmitted. The 30-day all-cause readmission rate was 8.5% while specific takotsubo readmission rate was 0.4%. The mortality rate in the index admission was 1.9% and 5.5% in readmitted patients. The mean age of index admission was 67.6years vs 70.7 years in readmission, about 89.0% were female in index admission vs 85.0% in readmission cohorts. The most common reasons for readmission were hypertensive heart disease with heart failure, hypertensive heart disease and chronic kidney disease with heart failure, takotsubo syndrome, sepsis, NSTEMI, COPD exacerbation, acute kidney failure, pneumonia, atrial fibrillation. Readmissions had more acute kidney injury (20.6% vs 11.3%, p-value <0.001) and atrial fibrillation (23.0% vs 13.0%, p <0.001) compared to the index admission, however the index admission had more ventricular tachycardia (4.6% versus 1.8%, p=0.02) compared to readmission cohorts. Readmission had longer length of hospital stay (4.9 days vs 3.7 days, p< 0.001), but less mean total hospital charge of (US$51039 vs US$60617, P =0.008). Older age, acute renal failure, pulmonary disease, coronary dissection, longer length of hospital stays and transfer to rehabilitation facility after discharge were identified as statistically significant predictors of readmissions. Conclusion: About one in twelve patients hospitalized with takotsubo cardiomyopathy were readmitted within 30days. Readmissions had a higher mortality rate; acute renal failure, pulmonary disease, coronary dissection were notable reasons for readmission. Understanding the predictors for readmission highlighted in this study would enable clinicians implement preventive strategies to improve the rate of takotsubo cardiomyopathy readmission

Incidence of Early Adverse Events Following Medial Patellofemoral Ligament Reconstruction.

The current literature lacks data regarding perioperative complications after medial patellofemoral ligament reconstruction (MPFLr). The objective of this study was to identify the incidence and predictors of adverse events in the first 90 days after MPFLr. Patients undergoing primary MPFLr between January 1, 2010, and December 31, 2019, were included. Predictors of readmission for any reason were identified using a multivariable logistic regression analysis. A total of 140 MPFLrs were included in the final analysis. Of these, 17 patients (12.1%) were admitted in the first 90 days after MPFLr. The most common reason for readmission was pain (7/140, 5%), followed by cellulitis (5/140, 3.5%). The only major complication was pulmonary embolism experienced by one patient (1/140, 0.7%). Univariate logistic regression analysis demonstrated that patients who ever smoked were 4.5 times (p = 0.005) more likely to be readmitted in the first 90 days. Although additional soft-tissue procedures increased the readmission rated by 21% (p = 0.810) and additional chondral procedure increased by 35% (p = 0.568), the multivariable analysis did not reveal a significant difference. Surgeons can use this information to counsel patients on what to expect following MPFLr.

Clinical profile of neonatal jaundice patients admitted in a tertiary care hospital in Khulna, Bangladesh

Background: A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in an otherwise healthy term infant is the most common reason for readmission to the hospital. Therefore, it is necessary to evaluate different aspects of neonatal jaundice in our clinical setup. Objective: The objective of this research was to find out different associated causes, clinical features, and treatment options for neonatal jaundice. Methods: A cross-sectional study was conducted in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh with a total number of 140 neonates with jaundice from January 2018 to January 2021. All data were collected and analyzed prospectively. Convenient purposive sampling was the sampling method. Results: In this study, 79.2% of neonates were full-term and 20.8% were preterm neonates. Physiological jaundice (33.5%) was found as the commonest type. Jaundice with infection was associated with 32.8% of cases. Jaundice with umbilical redness, discharge, and/or foul-smelling (17.9%), and reluctance to feed were commonly associated symptoms. Hepatomegaly and splenomegaly were detected in 7.1% and 3.6% neonates respectively. Phototherapy was given in 61% of cases and 17.8% (25) cases exchange therapy was required. In neonates with physiological jaundice, phototherapy was recommended for most of the cases. In the case of ABO and Rh incompatibility, exchange therapy was required most often along with phototherapy. Conclusion: Physiological jaundice is the most common pattern of neonatal jaundice. Most often, neonatal jaundice may co-exist with neonatal infections. In most cases, phototherapy is required along with or without exchange therapy, depending upon the associated causes and conditions. Mediscope 2024;11(2): 58-61

The relationship between daily blood glucose fluctuation and readmission in patients with acute coronary syndrome

Abstract Background Although the comprehensive diagnos and treatment of patients with acute coronary syndrome(ACS) has been greatly improved,the morbidity and mortality are still high. Previous literature has reported that about 70-75% of patients diagnosed with acute coronary syndrome have abnormal blood glucose metabolism1,and there existed gender differences. At present, most research results showed that elevated blood glucose is related to the prognosis of ACS. However, further intervention studies indicated that simply strengthen the reducement of blood glucose did not improve prognosis of these patients2. Glucose fluctuations, another dimension of blood glucose, reflect acute changes in blood glucose. However, there are few studies on the effect of blood glucose fluctuation on the prognosis of patients with ACS. Purpose This study aimed to explore the relationship between seven daily fluctuations of blood glucose and readmission in ACS patients. Methods In this study, a total of 664 patients admitted to our University from January 1, 2019 to December 31, 2019 were included and their blood glucose was monitored seven times a day during their hospitalization. The coefficient of variation of blood glucose (CV) was calculated from the results of seven daily blood glucose monitoring to represent the daily fluctuation of blood glucose. Univariate and multivariate regression analyses were performed to determine whether CV was an independent risk factor for re-hospitalization. In addition, the area under the curve (AUC) was used to evaluate the predictive efficacy of CV for outcome events. Finally, we performed a subgroup analysis based on gender and diabetes status to assess the association between CV and readmission in each subgroup. Results After a median follow-up of 21 months, the rate of readmission was 38.4%. Unstable angina pectoris (71.4%) and heart failure (16.4%) were the most common reasons for readmission. Patients with greater CV levels typically exhibited lower fasting blood glucose, higher post breakfast blood glucose, and higher admission blood glucose.The readmission rate increased with the increasing blood glucose variability after the cox regression analysis. Moreover, independent of glycated hemoglobin,CV could predict the risk of readmission in patients with ACS.When using 26.66% as the cutoff point of CV, the study population was divided into two groups and showed a significant differentiation for rehospitalization.In subgroup analysis, there was no significant association between seven daily blood glucose fluctuations and readmission in female and non-diabetes mellitus patients with acute coronary syndrome. Conclusions Besides some normal blood glucose index,seven daily fluctuations of blood glucose was associated with readmission in ACS patients. ACS patients who were male and combined with diabetes were more likely to be readmitted if their CV levels were greater.

Evaluation of patients who re-admitted to the emergency department within 24 hours

Aim: It was conducted to investigate the demographic and clinical characteristics of patients who re-admitted to the emergency department within 24 hours and to contribute to studies on reducing the re-admission rate. Methods: The data of patients who re-admitted to the emergency department within 24 hours between November 2021 and September 2023 in a secondary level public hospital were retrospectively examined. Data regarding the patients' demographic information, admission dates and times, clinical characteristics, examinations, diagnoses, consultations, hospitalization and referral status were obtained from the hospital automation system. Results: 496270 patients admitted to the emergency department during the study period. 6991 (1.4%) of the patients were admitted to the emergency department again within 24 hours. 40.3% of these patients were between the ages of 19-35 and 52.4% were women. The most common reason for re-admission to the emergency department was upper respiratory tract diseases. It was determined that 66.7% of the patients applied to the emergency department again 13-24 hours after their first admission. In their second admission, 43 patients were hospitalized or transferred for various reasons; It was determined that 1 of these patients died 5 months after being admitted to the intensive care unit. Conclusion: Effective triage practices, directing green area patients to family physicians, making the referral chain effective, increasing health literacy, making an accurate diagnosis, allocating appropriate time to patients and explaining the treatment and expectations from treatment, ensuring that patients referred to polyclinics are evaluated as soon as possible and returned to the emergency department will significantly reduce applications.

The Aftermath: Investigating Readmission And Mortality Trends In Older Adults

Abstract Background Acute hospital readmissions have significant implications for both the patient and the health service. Research has shown that up to 70 percent of hospital readmissions may be avoidable, while patients who are readmitted to hospital have a higher in-hospital mortality risk. The Health Service Executive has set a Key Performance Indicator of a readmission rate within 30 days of less than 11.1 percent. The purpose of this study is to identify the number of patients aged 75 years and older readmitted to a busy model four hospital within 30 days of their discharge. It will also quantify the number of deaths within this patient group. We aim to identify key areas where pathways for older adults could be developed to improve quality of care and reduce the overall burden on both the patient and acute hospital service. Methods Data was collected retrospectively for patients admitted between September 1st, 2023, and September 30th, 2023. Results In total 272 patients aged 75 years and older were admitted within a one-month period. 47 patients were admitted under the geriatric medicine service. The mean length of stay for all patients was 12.41 days. 160 patients were discharged directly home while 27 were discharged to long term care. The remaining patients were discharged to rehab, convalescence or hospice. 28 patients died during their inpatient stay. 6 patients died within one month of discharge. In total 13 patients were readmitted to hospital within one month following their discharge. 23 percent of patients died following readmission. The most common reason for readmission was a respiratory illness. Conclusion 4.7 percent of patients aged 75 years and older were readmitted to hospital within one month of discharge. This falls below the national target set by the HSE. However, there was a high mortality rate amongst those readmitted to hospital.

External validation of the natriuretic response prediction equation to discriminate diuretic response in heart failure.

Incomplete decongestion due to lack of titration of diuretics to effective doses is a common reason for readmission in patients with acute decompensated heart failure (ADHF). The natriuretic response prediction equation (NRPE) is a novel tool that proved to be rapid and accurate to predict natriuretic response and does not need urine collection. However, the NRPE has not been externally validated. The goal of this study was to externally validate the discrimination capacity of the NRPE in patients with ADHF and fluid overload. Patients admitted with ADHF who required intravenous loop diuretics were included. A spot urine sample was obtained ~2h following diuretic administration, and a timed 6-h urine collection by study staff was carried out. Urine sodium and urine creatinine from the spot urine sample were used to predict the 6-h natriuretic response using the NRPE. The primary goal was to validate the NRPE to discriminate poor loop diuretic natriuretic response (sodium output <50 mmol in the 6h following diuretic administration). The NRPE was compared with urine sodium and measured urine output which are the methods currently recommended by international guidelines to assess diuretic response. Eighty-seven diuretic administrations from 49 patients were analysed. Mean age of patients was 57±17 years and 67% were male. Mean estimated glomerular filtration rate was 65±28mL/min/1.73m2, and ejection fraction was 35±15%. Median dose of intravenous furosemide equivalents administered the day of the study was 80 mg (IQR 40 - 160). Poor natriuretic response occurred in 39% of the visits. The AUC of the NRPE to predict poor natriuretic response during the 6-h urine collection was 0.91 (95% CI 0.85-0.98). Compared with the NRPE, spot urine sodium concentration (AUC 0.75) and urine output during the corresponding nursing shift (AUC 0.74) showed lower discrimination capacity. In this cohort of patients with ADHF, the NRPE outperformed spot urine sodium concentration and all other metrics related to diuretic response to predict poor natriuretic response. Our findings support the use of this equation at other settings to allow rapid and accurate prediction of natriuretic response.

Extensive Colitis and Smoking Are Associated With Postoperative Complications Within 30 Days of Ileal Pouch-Anal Anastomosis.

Our understanding of outcomes after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) is largely based on analyses of selected populations. We created a state-level registry to evaluate the epidemiology of IPAA surgery and pouch-related outcomes across the major healthcare systems performing these surgeries in our state. We created a retrospective cohort of all patients undergoing restorative proctocolectomy with IPAA for UC at 1 of 4 centers between January 1, 2018, and December 31, 2020. The primary outcomes of this study were the rate of complications and all-cause readmissions within the first 30 days of the final stage of IPAA surgery. During the study period, 177 patients underwent IPAA surgery with 66 (37%) experiencing a complication within 30 days. After adjusting for the number of stages in IPAA surgery, patients with extensive UC (odds ratio, 3.61; 95% confidence interval, 1.39-9.33) and current or former smokers (odds ratio, 2.98; 95% confidence interval, 1.38-6.45) were more likely to experience a complication. Among all patients, 57 (32%) required readmission within 30 days. The most common reasons for readmission were ileus/small bowel obstruction (22%), peripouch abscess (19%), and dehydration (16%). In this first state-level examination of the epidemiology of IPAA for UC, we demonstrated that the complication rate after IPAA for UC was 37%, with one-third of patients being readmitted within 30 days. Extensive disease at the time of colectomy appears to be an indicator of more severe disease and may portend a worse prognosis after IPAA.

Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey.

Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear. To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD). We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group. Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.

SHORT-TERM COMPLICATIONS AND REOPERATION RATES AFTER HIP ARTHROSCOPY: A REVIEW OF 22,401 CASES IN ENGLAND FROM 2010 TO 2023

Hip arthroscopy (HA) is an effective treatment for various hip conditions but has a steep learning curve and its effect on long-term joint preservation is unclear. This study uses population-level data to assess (1) the 90-day complication rate, and (2) the frequency and timing of revision HA, total hip replacement (THR), and pelvic osteotomy (PO) following primary HA.We performed a retrospective analysis of the National Hospital Episode Statistics database, examining all patients who underwent primary HA in NHS hospitals in England from 2010 to 2023 using relevant OPCS-4 codes. We evaluated patient demographics, 90-day complications, and reoperation rates for revision HA, THR, and PO. Descriptive statistical analyses were performed to calculate frequencies and average time to reoperations.We included 22,401 HA procedures in the study. The mean LOS was 0.82±2.04 days. The 90-day readmission rate was 0.17% at a mean of 54.4±8.1 days. The most common reasons for readmission were reoperation (0.071%), followed by infection (0.031%), pulmonary embolism (0.027%), pain (0.022%), bleeding (0.018%), and deep vein thrombosis (0.004%). One patient died within 90 days.Overall, 4942 patients (22.1%) required further surgery at a mean of 2.71±2.27 years. The rates of revision HA, conversion to THR, and PO were 6.94%, 14.6%, and 0.50% at a mean of 2.39±1.79, 2.87±2.46, and 2.26±1.80 years respectively. Female patients had higher rates of reoperation than males for conversion to THR (9.99% vs 4.63%), revision HA (4.92% vs 2.02%), and subsequent PO (0.43% vs. 0.06%) (p&lt;0.001).This study demonstrates a low short-term complication rate after primary HA, supporting existing literature. However, a large proportion of patients required further surgery, especially females. These findings highlight the need for careful patient selection and counselling before HA to optimise outcomes, as well as further research on factors influencing longer-term outcomes and cost-effectiveness.

Frequency of Readmission Among American Society of Anesthesia Classification after Total Hip and Total Knee Arthroplasty

Background: With the aging population and the increasing prevalence of degenerative joint diseases, the need for total joint arthroplasty (TJA) has surged. The American Society of Anesthesiologists (ASA) Physical Status Classification System plays a pivotal role in preoperative evaluation, predicting the risk of postoperative complications and mortality. Understanding the impact of ASA classification on surgical outcomes can guide improvements in patient care and surgical planning. Objective: This study aimed to investigate the relationship between ASA classification and the risk of postoperative readmission in patients undergoing total joint arthroplasty. Methods: Conducted at a single urban medical center, this descriptive, non-randomized study involved 352 patients who underwent primary TJA due to osteoarthritis, rheumatoid arthritis, or avascular necrosis. Participants were assigned an ASA classification preoperatively. The primary outcome measured was readmission within three months post-surgery, with secondary outcomes including the incidence of complications such as deep vein thrombosis (DVT), pulmonary embolism, and surgical site infections. Data were analyzed using SPSS version 21, with significance set at p&lt;0.05. Results: Of the 352 participants, 165 (46.9%) were from rural areas, and 187 (53.1%) were from urban locations. The readmission rate was 6.8%, with ASA III and IV classifications showing significantly higher readmission rates (9.7% and 28.6%, respectively) compared to ASA I and II (1.8% and 4.4%). The most common reasons for readmission were chest infections (37.5%), followed by cardiac complications, pulmonary embolism, and neurological complications (20.8% each). The study found a significant correlation between higher ASA classification and increased readmission risk (p=0.021). Conclusion: Higher ASA classifications are associated with a greater risk of postoperative readmission in patients undergoing total joint arthroplasty. These findings underscore the importance of comprehensive preoperative assessments and tailored postoperative care strategies to mitigate the risk of readmission, particularly in patients with higher ASA scores.

Risk Factors for Re-admission in Covid-19 Patients from a Tertiary Care Health System: Quality Control (QC) and Quality Improvement (QI) Project

The COVID-19 pandemic has made a significant impact on public health globally and has unleashed an array of deficiencies that have already crippled our health care system. It also brought out the health care disparities among minorities and thrust health inequity to the limelight. Hospital readmission is one descriptive marker for overall patient clinical prognosis. Prior to SARS-CoV-2 Pandemic (COVID-19), 30-day-all cause readmission rates was highest in patients with heart failure, psychoses, chronic lung disease, and peripheral vascular disease status post-surgical procedure. However, pneumonia is the most common reason for unplanned patient readmission. COVID-19 continues to evolve, from the rising versality in variants to the clinical concerns of longer haulers. This study followed by a review will illustrate COVID-19 post-acute disease role on readmission diagnosis and rates. The aim is to identify most common reason for readmission and overall patient clinical prognosis. Readmitted patients in this study were older.&#x0D; In this QC/QI project the frequent symptom on readmission was respiratory illness and the primary diagnostic codes on readmission were noted to be respiratory failure and “COVID-19 sequelae.” Readmitted patients in this study were older (&gt;61yrs of age), with an equal sex distribution, more likely to have multiple comorbidities, majority were of African American ethnicity, reflecting the disproportionate impact ofCOVID-19 on this group. About 70% of readmissions had a Charlson Comorbidity index of 3 and above reflecting the chronic conditions present in this cohort. Less than 40% of patients were up to date with their COVID 19 immunization and overall mortality rate was close to 12%. Based on our QC/QI analysis, a comprehensive and coordinated approach that addresses important metrics comprising optimal medical management of comorbidities, COVID 19/Pneumococcal immunizations, focus on mental health treatment and homelessness is essential to decrease the risk for readmissions in this population.

Rate and Causes of Unplanned Hospital Returns within 60 Days following Head and Neck Surgery.

Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score ( p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost.

Background: Bundled payments for total joint arthroplasty (TJA) were instituted by the Centers for Medicare and Medicaid Services (CMS) to reimburse providers a lump sum for operative and 90-day postoperative costs. Gaining a better understanding of which TJA patients are at risk for early return to the operating room (OR) is critical in preoperative optimization of those with modifiable risks, which could improve bundled-payment performance. Purpose: We sought to identify the most common reason for readmissions, as well as patient characteristics and costs, associated with early return to the OR among TJA patients. Methods: This was a retrospective cohort study of Medicare patients who had undergone primary total hip or knee arthroplasty (THA or TKA) between 2013 and 2018 at a tertiary care hospital. We used the CMS research identifiable files database to identify the most common reasons for readmissions and revisions within 90 days of surgery. Total billing claims were used to determine the cost of early readmissions and revisions. Multivariate regression analysis was used to determine the characteristics associated with early readmission or revision. Results: Out of 20 166 primary TJA patients identified, we found 1349 readmissions (5.6%) and 163 (0.8%) revisions within 90 days of surgery. Dislocation was the most common indication for readmission, and periprosthetic joint infection was the most common indication for revision. Early return to the OR was associated with a mean $105,988 (standard deviation [SD] = $76,865) in CMS claims for the inpatient stay. Factors associated with a higher risk of early reoperation were female sex, THA, longer length of stay, and discharge to long-term care facility. Conclusions: This retrospective cohort study found that early return to the OR after TJA increased overall 90-day costs by 260%, suggesting that early reoperation might have a significant impact on bundled payments. Further study is warranted.

Nurses' perspectives on the provision of self-care management education to patients with heart failure: A qualitative study at Cardiac Hospital, Dar es Salaam Tanzania.

Patients' education along with a motivation for developing self-care management skills is an essential component in the management of heart failure(HF). Self-care management education has been practiced by nurses in many hospitals. However, there is inadequate evidence for the provision of self-care management education in low-income countries including Tanzania. Lack of self-care management education to patients with HF during discharge is the most common reason for re-admission to hospitals. This study aimed to explore nurses' perspectives focusing on facilitators and barriers to the provision of self-care management education to patients with heart failure at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. This study used a qualitative descriptive design. Purposive sampling was used to recruit 12 study participants. In-depth interviews were used to collect the data. We used thematic analysis to come up with the themes and sub-themes. The two major themes emerged from this study; The first theme is "Improved patient quality of life and health outcome" which describes factors that motivate nurses to continue giving self-care management education to heart failure patients. The second theme is "Reduced effective uptake of self-care management education" which describes nurses'perspectives on barriers for providing self-care management education to heart falure patients. Nurses highlight some barriers while providing self-care management education to patients with heart failure including;inadequate knowledge of self-care management among nurses, lack of privacy during the provision of self-care education, poor communication skills among nurses, and lack of learning materials. Also, nurses pointed out facilitators that influence the provision of self-care management education such as increased involvement of family members and the use of peer educators. Poor self-care management for patients with heart failure results in readmission and prolonged hospital stay. Family involvement and the use of peer educators are the key steps in the improvement of self-care management for patients with HF. However, patient cognitive impairment and poverty which contribute to poor health outcomes, should be taken into consideration when planning for discharge for patients with HF. Self-care management education should be part of routine health care.

Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation.

Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.

Abstract 17240: Preoperative Pectoralis Muscle Area Index is Associated With Increased Post-LVAD Length of Stay and 90-day Readmission

Background: In LVAD pts, preoperative sarcopenia, as measured by pectoralis muscle area index (PMI), has been associated with mortality and GI bleed; however, the association with length of stay (LOS) and readmission is unknown. Methods: This was a single-center retrospective cohort study of pts who underwent LVAD 01/2015-10/2018. Preoperative pectoralis muscle area was measured on CT chest prior to implant using Tera Recon, adjusted for height squared to give the PMI. Multivariable negative binomial regressions were used to assess the association between PMI and LOS. Subhazard ratios (SHR) and cause-specific hazard ratios (CSHR) were used to assess the association between PMI and freedom from 90-day readmission. Results: Of 254 LVAD pts, 95 had a preop CT chest and were included (median days CT to LVAD: 7 [IQR 3-13]). Pts with PMI in the lowest quartile (PMI &lt; 4.86 cm 2 /m 2 ) constituted the low PMI cohort; all others served as the reference cohort. Baseline characteristics are shown in the Table. During index hospitalization, 2 low PMI pts died vs 7 reference; 0 low PMI pts were transplanted vs 2 reference. Low PMI was associated with longer post-LVAD LOS (adjusted incidence rate ratio 1.31 [95% CI 1.03-1.66], p =0.03) and increased risk of 90-day readmission (aSHR, accounting for risk of death and transplantation, 3.77 [1.17-12.1], p =0.03; aCSHR 3.67 [1.35-9.96], p =0.01) (Fig). The most common reason for readmission in low PMI pts was infection (n=3). Conclusions: Low PMI is associated with longer LOS and higher likelihood of 90-day readmission after LVAD. PMI could be used to identify sicker patients at risk for more intensive medical intervention and potentially higher health care cost.

Sex differences in readmission rate after cardiac surgery.

The impact of sex on hospital readmission rate after cardiac surgery is unclear. Therefore, we aimed to analyse sex-specific differences and underlying factors in 30-day readmission rate after cardiac surgery. We conducted a single center study including all patients after major cardiac surgery (excluding aortic dissection and left ventricular assist device implantation) from January 2012 to September 2020. Reasons for readmission were adjudicated according to all available medical records. We calculated incidence rate ratios (IRR) with 95% confidence intervals (CI) for female sex with re-admission crude and adjusted for plausible confounding factors using negative binomial regression. 4,868 patients were included in the analysis. The median [Interquartile range] age was 68 [60 to 74] years and 24% (n = 1,149) of the patients were female. Female patients were significantly older (median [IQR] age 70 (63 to 76) vs. 67 (59 to 74), p < 0.001) and had lower body mass index and fewer cardiovascular risk factors compared to men. Isolated valve surgery was more frequent in female while coronary artery bypass grafting was more often in men. 30-day readmission was comparable between both sexes (7.0% [n = 81] in female vs. 8.7% [n = 322] in men; p = 0.078). Cardiac related readmissions and infections were the most common reasons for readmission in both groups. The overall incidence rate ratios of female sex with readmission (0.80, 95% CI 0.63 to 1.03, p = 0.078) remained robust after adjustment for EuroSCORE 2 (0.78, CI 0.61 to 1.0, p = 0.051). Readmission rate and reasons for 30-day readmission after major cardiac surgery were similar between men and women.

Thirty-Day Readmissions Are Largely Not Preventable in Patients With Cirrhosis.

Hospital readmissions are common in patients with cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population. We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed up for 30 days postdischarge. Demographic, clinical, and socioeconomic data, functional status, and quality of life were collected. Readmission preventability was independently and systematically adjudicated by 3 reviewers. Multinomial logistic regression was used to compare those with (i) preventable readmission, (ii) nonpreventable readmission/death, and (iii) no readmission. Of 654 patients, 246 (38%) were readmitted, and 29 (12%) were preventable readmissions. Reviewers agreed on preventability for 70% of readmissions. Twenty-two (including 2 with preventable readmission) died. The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%), and these reasons were similar between preventable and nonpreventable readmissions. Preventable readmission was often related to paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment. Compared with nonreadmitted patients, preventable readmission was independently associated with racial and ethnic minoritized individuals (odds ratio [OR] 5.80; 95% CI, 1.96-17.13), nonmarried marital status (OR 2.88; 95% CI, 1.18-7.05), and admission in the prior 30 days (OR 3.45; 95% CI, 1.48-8.04). For patients with cirrhosis, readmission is common, but most are not preventable. Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, nonmarried status, and prior admissions.

Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors

BACKGROUND CONTEXTAlthough outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSEThis study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEPatients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURESHospital readmission within 30 postoperative days. METHODSPatients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTSA total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSIONThis study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.