Common Reasons For Readmission Research Articles

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

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

S1067 Endoscopic Sleeve Gastroplasty vs Intragastric Balloon: A Large, Database Analysis of Early Safety and Efficacy

Introduction: Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are the two most common endoscopic bariatric therapies currently performed in the United States. Procedural selection is often based primarily on patient preference. There is a lack of comparative data to help guide patient discussions regarding these interventions. This study is the largest study to date to directly compare short-term safety and efficacy of IGB to ESG using a large international bariatric database. Methods: All patients undergoing ESG and IGB across 800 hospitals in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2016-2020 were included. All patients undergoing IGB were propensity matched to patients undergoing ESG. We compared occurrences of serious adverse events (SAE), readmissions, re-interventions, and emergency room (ER) visits within 30-days after procedure. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (TBWL) measured at 30 days. (Table) Results: A total of 1,996 patients underwent IGB and 6,054 patients underwent ESG. All IGB patients were propensity matched to 1,996 ESG patients, with no differences in baseline characteristics. ESG and IGB had similarly low rates of SAE (p > 0.05). ESG had more readmissions within 30 days (p< 0.05). IGB had more outpatient treatments for dehydration and re-interventions within 30 days (p< 0.05), with 3.7% of patients reporting early balloon removal less than 30 days after implantation. ESG had greater %TBWL at 30 days (p< 0.05). Conclusion: ESG and IGB are both safe procedures with comparably low rates of SAE. ESG is perhaps better tolerated than IGB. Table 1. - ‡ Most common reason for readmission after both procedures was nausea, vomiting, and fluid/electrolyte or nutritional depletion. § Most common type of intervention after IGB was early IGB removal. The most common intervention after ESG was therapeutic endoscopy with stent placement or dilatation Comparing Short Term (30d) Procedural Outcomes of Endoscopic Sleeve Gastroplasty and Intragastric Balloon Placement ESG (n=1998) IGB (n=1998) p Mean BMI (SD) 36.36 (6.19) 36.17 (6.16) 0.316 Mean Change from Pre-Op to Post-Op BMI (SD) -1.51 (2.41) -0.95 (2.83) < 0.001 Mean % Total Body Weight Loss (%TBWL) (SD) 3.8% (7.9%) 2.3% (6.6%) < 0.001 Mean Number of Days from Procedure to Discharge (SD) 0.65 (1.76) 0.04 (0.33) < 0.001 Mean Procedure Length, minutes (SD) 64.97 (45.39) 16.51 (17.12) < 0.001 Serious Adverse Event, n (%) 17 (0.9) 5 (0.3) 0.055 Reoperation, n (%) 22 (1.1) 12 (0.6) 0.121 Readmission, n (%) ‡ 56 (2.8) 29 (1.5) 0.004 Re-Intervention, n (%) § 35 (1.8) 90 (4.5) < 0.001 Received Treatment for Dehydration Outpatient, n (%) 46 (2.3) 89 (4.5) < 0.001 Emergency Department Visit Not Resulting in Admission, n (%) 66 (3.3) 69 (3.5) 0.861

Worse Outcomes After Readmission to a Different Hospital After Sepsis: A Nationwide Cohort Study

BackgroundIn the United States, sepsis accounts for 13% of the total hospital expenses and > 50% of hospital deaths. Moreover, people with sepsis are more likely to be readmitted. ObjectiveThe aim of this study was to assess the prevalence and outcomes of different hospital readmissions (DHRs) in patients with sepsis, and the factors associated with DHR. MethodsWe used data from the Nationwide Readmissions Database of the United States in 2017 to identify patients admitted for sepsis. Multivariable logistic regression analysis was used to evaluate the factors associated with DHR; five models were constructed to elucidate the relationship between DHR and in-hospital outcomes. ResultsIn 2017, 85,120 (21.97%) of all patients with sepsis readmitted within 30 days in the United States were readmitted to a different hospital. The most common reason for readmission was infection irrespective of hospital status. Compared with the patients with sepsis who were readmitted to the same hospital, DHR was associated with higher hospitalization costs ($2264; 95% CI $1755–$2772; p < 0.001), longer length of stay (0.58 days; 95% CI 0.44–0.71 days; p < 0.001), and higher risk of in-hospital mortality (odds ratio 1.63; 95% CI 1.55–1.72; p < 0.001). ConclusionsDHR occurred in one-fifth of patients with sepsis in the United States. Our findings suggest that patients readmitted to a different hospital within 30 days may experience higher in-hospital mortality, longer length of stay, and higher hospitalization costs. Future studies need to examine whether continuity of care can improve the prognosis of patients with sepsis.

Racial Disparities in Early Adverse Events and Unplanned Readmission after Open Fixation of Below- Knee Fractures

Category: Trauma; Ankle; Hindfoot; Other Introduction/Purpose: Race-based differences in the surgical management of hip fractures are well-established. Studies assessing these disparities for below-knee fractures have yet to be conducted despite their high volume. Our purpose was to determine whether 1) early postoperative complications and 2) time to surgery for operative fixation of below-knee fractures differ for black versus white patients, and to assess whether disparities exist between fracture subtypes. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients (&gt;=18 years) undergoing open fixation of below-knee fractures between 2010-2019. This yielded 9,172 patients; 1,120 (12%) were black. We collected patient demographics and preoperative risk factors. Primary outcomes were 30-day postoperative complications and time to surgical fixation. Fractures were further subclassified as tibia and/or fibula shaft, isolated malleolar, bi/trimalleolar, and pilon fractures. Nearest-neighbor propensity score matching in a 1:1 ratio was applied to compare outcomes by race. Alpha = 0.05. Results: After matching, we identified 1,120 white patients with equal propensity scores as our black patients. Black patients had 1.5 times higher odds (95% confidence interval [CI]: 1.0-2.0) of experiencing any early adverse event when compared with matched white counterparts. Blacks also had 1.9 times higher odds (95% CI: 1.2-3.0) of requiring unplanned readmission within 30 days of operative fixation. Fifty-eight black patients (5.3%) required short-term readmission, compared with 351 white patients (4.5%) - 32 (2.9%) in the matched cohort. The most common reasons for readmission were wound, gastrointestinal, thromboembolic, and recurrent musculoskeletal complications for both races. There were no significant differences by race in time to surgery. Fracture subtype was not associated with postoperative complications or time to surgery in the multivariable analysis. Conclusion: Racial disparities in the early postoperative course after open fixation of below-knee fractures exist, with significantly higher rates of early adverse events and unplanned readmission for black versus white patients that persist after propensity matching. These trends may be secondary to a host of community- and hospital-level factors, illustrating the importance of interventions that consider the differences between hip and non-hip fractures and increase resources to vulnerable areas.

Evaluation of risk factors for unanticipated hospital admission following ambulatory surgery - An observational study.

Unanticipated admissions following ambulatory surgery significantly affect hospital admission and operation room flow. Most of the factors responsible for unanticipated admission following ambulatory surgery were preventable. It is, therefore, crucial to improve patient selection criteria and to identify the risk factors for unanticipated admission during preoperative period. These unanticipated admissions have now been considered as quality care indicator and a target to improve healthcare costs. To assess the reasons and risk factors for unanticipated hospital admission after ambulatory surgery. Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. In this case-control study, cases who were re-admitted within 48 hours following ambulatory surgery were included. The convenience sampling was used to identify controls. Data including patients' demographics, type of anesthesia and surgery, any intraoperative or postoperative complications, etc., were extracted. Descriptive statistics is used to summarize the study variables. Mean and standard deviation were used for quantitative variables. Percentage and frequencies were used for qualitative variables. Univariate and multivariate logistic regressions were used to assess risk factors for unanticipated hospital admission after ambulatory surgery. There were 153 cases and 147 controls in this study. The study found postoperative pain as the most common reason for re-admission after ambulatory surgery followed by bleeding, fever, and asthma exacerbation. Multivariate logistic regression showed age, BMI more than 40, and presence of respiratory disease as risk factors (P < 0.05). Age, high BMI more than 40, and presence of respiratory disease increase the risk of unanticipated hospital admission after ambulatory surgery.

S125 Predictors and Causes of 30-Day Readmissions in Primary Biliary Cholangitis: Analysis of the Nationwide Readmission Database

Introduction: Primary biliary cholangitis (PBC) is an autoimmune disorder that most commonly affects middle-aged women. Cirrhosis, hepatocellular carcinoma, metabolic bone disease, and malabsorption can complicate PBC. In this study we aimed to describe the causes and predictors of 30-day readmissions in patients with PBC. Methods: This was an observational retrospective study involving adult patients hospitalized with PBC in the US. We utilized the Nationwide Readmission Databases 2016 to 2019. The first hospitalization for PBC within the year was marked as the index admission. We identified one subsequent hospitalization within 30 days, this was marked as a readmission. We analyzed the rates, causes, and outcomes of the readmitted cohort. We used multivariable cox regression analysis to identify independent predictors of readmissions. Results: We included a total of 3954 hospitalizations with PBC as the primary diagnosis for admission. 30.5% of the discharged cohort were readmitted within 30 days. Excluding PBC, the most common reasons for readmission were hepatic failure (9.6%) and sepsis (6.7%). Fluid and electrolyte disorders were the most common comorbidities in both the index hospitalization and readmission cohorts. Mortality was higher in the readmitted patients compared to index hospitalizations (10.1% and 4.3%, respectively, p < 0.001). Predictors of 30-day readmissions were peptic ulcer disease (aHR 1.64, p = 0.040), renal failure (aHR 1.29, p = 0.038), weight loss (aHR 1.28, p = 0.024), fluid and electrolyte disorders (aHR 1.28, p = 0.011), and coagulopathy (aHR 1.22, p = 0.029). Conclusion: Patients with PBC have high readmission rates, these readmissions are associated with high inpatient mortality. PBC patients are at risk of liver cirrhosis and malabsorption which explains the high rates of sepsis and electrolyte abnormalities observed in our study. Coagulopathy and weight loss might be reflective of the severity of liver dysfunction and the malabsorptive state, hence, there were associated higher readmission risk. Excellent short and long-term survival have been described following liver transplantation for PBC patients. However, recent data demonstrated that they have higher wait-list mortality among patients listed for liver transplantation.

TU2.12 Experience of Elective Colorectal Cancer Surgery at District General Hospital (DGH): Single centre study

Abstract Background Elective colorectal resection surgery is one of the most common surgical procedures performed for bowel cancer treatment. This study evaluates the whole practice of colorectal cancer surgery in a DGH in England. Aims The primary outcome is to measure postoperative length of stay (LOS), with secondary outcomes including approach of surgical operation and conversion rate, R0 resection, VTE prophylaxis and its compliance with NICE guidelines, postoperative DVT over a period of one year, readmission rate within 30 days of discharge and reasons for readmission. Methods A single centre, retrospective, observational study was performed over a period of a year from January 2018 –January 2019. Patients were eligible for study inclusion if they had undergone planned surgical resection for colorectal cancer after being discussed in the local colorectal cancer MDT. Results A total of 123 patients were included. Mean length of stay was 7.97 days. 74.7% of the procedures were performed by laparoscopic approach with conversion rate of 6.5%. R0 resection was achieved in 95.1%. 96.7% of patients who underwent surgery for colorectal cancer received extended VTE prophylaxis as per NICE guidelines. Six patients had developed post-operative DVT and one inpatient death recorded. 13.8% of patients that underwent colorectal surgery for cancer were readmitted within 30 days of discharge. SBO, abdominal/pelvic collection, wound dehiscence and SSI as the most common reasons for readmission. Conclusion Laparoscopic approach is the preferred method for elective colorectal resection surgeries with acceptable measures of patient outcome including R0 resection, postoperative length of stay, DVT and readmission rate.

Costs and 30-day readmission after lower limb fractures from motorcycle crashes in Queensland, Australia: A linked data analysis

BackgroundLower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes. MethodsThis retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011–2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA. ResultsA total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01–1.94); chronic anaemia (OR 2.19, 95% CI 1.41–3.39); current/ex-smoker (OR 1.60, 95% CI 1.21–2.12); emergency admission (OR 2.77, 95% CI 1.35–5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059). ConclusionsUnplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.

Rate of 30-day Readmission & Economic Burden of Patients with Acute Congestive Heart Failure with Co-existing Metabolic Syndrome

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Heart failure (HF) and meta-bolic syndrome (MetS) are commonly co- exist. MetS are known to be one of the risk factors of HF, and it can also act as a comorbidity in HF. Mets is an independent risk factor for cardiovascular disease, however its impact on HF outcomes is incompletely understood. <h3>Objective/Purpose</h3> We sought to determine the 30-Day Readmission rate (30-DRr) of patients with Acute Congestive Heart Failure (aCHF) & Co-existing Metabolic Syndrome (MetS) & its impact on mortality, clinical outcomes & healthcare utilization in the United States. <h3>Methods</h3> Using the 2017 & 2018 National Readmission Database, we conducted a retrospective analysis of patient discharges with aCHF as a principal diagnosis & MetS as a secondary diagnosis according to ICD-10 codes. Readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index admission. Same-day admissions & discharges were excluded. The primary outcome was 30DRr, while secondary outcomes were readmission mortality rate, most common diagnoses (MCD's) for readmission, & resource utilization defined by length of stay (LOS), Average & Total Patient Charge (TPC), & Average and Total Hospital Cost (THC). <h3>Results</h3> A total of 530 index hospitalization for aCHF with co-existing MetS. Index vs. Readmission Cohorts had a mean age of 62.2 years vs. 60.6 years, Males (51.6% vs. 61.1%). In- hospital mortality rate for index admission was 1.7%, while 30-DRr was 13.6% (Figure 1). Among this group of readmitted patients, in-hospital mortality rate was 2.2%, compared to index admission (2.2% vs. 1.7%, adjusted p-value=0.1). The total hospital days associated with readmission were 460 days, with a THC of $1,144,028 & TPC of $3,555,453. <h3>Conclusions</h3> In patients with aCHF & MetS, we observed a high readmission rate of ∼1 in 7 readmitted. There was subsequent higher mortality with the readmitted patient, but this was not statistically significant. Heart Failure, Acute Kidney Injury, Atrial Fibrillation, ASCVD were the most common reasons for readmission and were associated with a higher economic health care burden. A higher risk for hypertensive heart failure among MetS patients & a more significant proportion of patients with CKD & AF may indicate a higher risk for HFpEF. Comprehensive management involving a multidisciplinary team is necessary for managing patients with metabolic syndrome and heart failure to help alleviate the health care burden. Further research focusing on the HF subtypes among MetS & HF is needed to help understand specific patient populations at risk & thereby help alleviate the health care burden.

Heart Failure Telemedicine: The New Frontier for High-Risk Heart Failure Patients

Background: Heart Failure (HF) is a disease with high morbidity and mortality. The prevalence of HF in the United States in 2020 was 6.9 million. Hospital readmissions for HF patients age greater than 65 remain the most common reason for readmission. Readmissions for HF within 30 days of discharge are still as high as 25% nationally despite substantial improvements in HF care.

Adverse outcomes after minimally invasive surgery for pelvic organ prolapse in women 65 years and older in the United States.

To describe complications at the time of surgery, 90-day readmission and 1-year reoperation rates after minimally invasive pelvic organ prolapse (POP) in women > 65 years of age in the US using Medicare 5% Limited Data Set (LDS) Files. Medicare is a federally funded insurance program in the US for individuals 65 and older. Currently, 98% of individuals over the age of 65 in the US are covered by Medicare. We identified women undergoing minimally invasive POP surgery, defined as laparoscopic or vaginal surgery, in the inpatient and outpatient settings from 2011-2017. Patient and surgical characteristics as well as adverse events were abstracted. We used logistic regression for complications at index surgery and Cox proportional hazards regression models for time to readmission and time to reoperations. A total of 11,779 women met inclusion criteria. The mean age was 72 (SD ± 8) years; the majority were White (91%). Most procedures were vaginal (76%) and did not include hysterectomy (68%). The rate of complications was 12%; vaginal hysterectomy (aOR 2.4, 95% CI 2.2-2.7) was the factor most strongly associated with increased odds of complications. The 90-day readmission rate was 7.3%. The most common reason for readmission was infection (2.0%), three quarters of which were urinary tract infections. Medicaid eligibility (aHR 1.5, 95% CI 1.3-1.8) and concurrent sling procedures (aHR 1.2, 95% CI 1.04-1.4) were associated with a higher risk of 90-day readmission. The 1-year reoperation rate was 4.5%. The most common type of reoperation was a sling procedure (1.8%). Obliterative POP surgery (aHR 0.6, 95% CI 0.4-0.9) was associated with a lower risk of reoperation than other types of surgery. US women 65 years and older who are also eligible to receive Medicaid are at higher risk of 90-day readmission following minimally invasive surgery for POP with the most common reason for readmission being UTI.

Neuromuscular diseases in the pediatric intensive care unit: 11 years of experience from a tertiary children’s hospital

Background &amp; Objective: We present 11-year data of patients with neuromuscular disease (NMD) that were treated in the pediatric intensive care unit of a tertiary children’s hospital. Methods: The data of all cases followed-up in the pediatric intensive care unit (PICU) were retrospectively analyzed. Patients were evaluated in terms of age, gender, diagnosis, PRISM, neuroanatomical localization, hospitalization time-age, cause of admission to pediatric intensive care unit, clinical course, complications and clinical discharge status. Results: A NMD was detected in 43 of the 1,411 patients admitted within the study period and accounted for approximately 3% of pediatric intensive care unit admissions. NMD consisted of genetic (n= 35, 74.8%), acquired (n=6, 13.8%) and metabolic (n=2, 4.6%) causes. The diagnoses included spinal muscular atrophy type 1 (n=12, 27.9%), Duchenne and Becker muscular dystrophy (n=7, 16.2%), congenital myopathy (n=6, 13.9%), congenital muscular dystrophy (n=5, 11.6%), Guillain-Barre syndrome and its variants (n=2, 4.6%), spinal muscular atrophy associated with respiratory distress type 1 (n=2, 2.3%), critical illness neuropathy (n=2, 4.6%), acute flaccid myelitis (n=2, 4.6%), congenital myasthenic syndrome (n=1, 2.3%), peripheral neuropathy associated with disorder of riboflavin transporter (n=1, 2.3%), juvenile amyotrophic lateral sclerosis (n=1, 2.3%), stress-induced childhood-onset neurodegeneration with ataxia and variable seizures (n=1, 2.3%), and metabolic myopathy (n=1, 2.3%). Respiratory complications (n=31, 72%) were the most common reasons of admission to the pediatric intensive care unit. Seven (16.2%) patients have the NMD diagnosis confirmed during their first admission in PICU. These included both genetic cause of NMDs (n=4) and acquired NMDs (n=3). Mortality rate was 6.9% (n=3). Forty-three patients diagnosed with NMD had 75 times PICU admissions. The disease with the highest rate of re-admission to the PICU was SMA type 1, and the most common reason for re-admission was respiratory reasons. Conclusion: Accurate diagnosis of NMD and knowledge of causes of admission to PICU is crucial for increasing awareness, sensitivity and effectiveness when treating these diseases.

Examination of a social-learning program implemented in a maximum-security state hospital setting.

The present study examines the extent to which clients with serious mental illnesses (SMI) enrolled in a social-learning program (SLP) within a maximum-security state hospital were able to achieve discharge to less restrictive settings without requiring a return to maximum security. Retrospective analyses were undertaken to examine several time periods of the SLP's operation within maximum security. From 1988 to 2019, 248 clients were discharged from the SLP. Only 20 were readmitted to maximum security, primarily for violence in less restrictive facilities. The proportion of clients who were discharged from one 19-bed ward offering the SLP differed significantly from the proportion of clients who were discharged from an identical 19-bed ward offering treatment as usual within maximum security from 1988 to 1995. The rate of readmission to maximum security was also significantly lower for clients treated on the SLP than for clients treated on other long-term treatment programs within maximum security from 2010 to 2019. Violence in a less restrictive facility was the most common reason for readmission, which typically occurred more than 1 year after discharge. The results of the present study demonstrate the SLP's success in discharging clients with SMI from a maximum-security state hospital. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cost and economic determinants of paediatric tonsillectomy.

Objective Hospital utilisation research is important in pursuing cost-saving healthcare models. Tonsillectomy is one of the most common paediatric surgeries and the most frequent reason for paediatric hospital readmission. This study aimed to report the government-funded costs of paediatric tonsillectomy in the state of Victoria, Australia, extrapolate costs across Australia, and identify the cost determinants. Methods A population-based longitudinal study was conducted with a bottom-up costing approach using linked datasets containing all paediatric tonsillectomy and tonsillectomy with adenoidectomy surgeries performed in the state of Victoria between 2010 and 2015. Results The total average annual cost of tonsillectomy hospitalisation in Victoria was A$21 937 155 with a median admission cost of A$2224 (interquartile range (IQR) 1826-2560). Inflation-adjusted annual tonsillectomy costs increased during 2010-2015 (P < 0.001), not explained by the rising number of surgeries. Hospital readmissions resulted in a total average annual cost of A$1 427 716, with each readmission costing approximately A$2411 (IQR 1936-2732). The most common reason for readmission was haemorrhage, which was associated with the highest total cost. The estimated total annual expenditure of both tonsillectomy and resulting readmissions across Australia was A$126 705 989. Surgical cost in the upper quartile was associated with younger age, male sex, lower socioeconomic status, surgery for reasons other than infection alone, overnight vs day case surgery, public hospitals and metropolitan hospitals. Surgery for obstructed breathing during sleep had the strongest association to high surgical cost. Conclusions This study highlights the cost of paediatric tonsillectomy and associated hospital readmissions. The study findings will inform healthcare reform and serve as a basis for strategies to optimise patient outcomes while reducing both postoperative complications and costs.

A novel online calculator to predict nonroutine discharge, length of stay, readmission, and reoperation in patients undergoing surgery for intramedullary spinal cord tumors

BACKGROUND CONTEXTIntramedullary spinal cord tumors (IMSCTs) are rare tumors associated with significant morbidity and mortality. Surgical resection is often indicated for symptomatic lesions but may result in new neurological deficits and decrease quality of life. Identifying predictors of these adverse outcomes may help target interventions designed to reduce their occurrence. Nonetheless, most prior studies have employed population-level datasets with limited granularity. PURPOSETo determine independent predictors of nonroutine discharge, prolonged length of stay (LOS), and 30 day readmission and reoperation, and to deploy these results as a web-based calculator. STUDY DESIGNRetrospective cohort study PATIENT SAMPLEA total of 235 patients who underwent resection of IMSCTs at a single comprehensive cancer center. OUTCOME MEASURESNonroutine discharge, prolonged LOS, 30 day readmission, and 30 day reoperation METHODSPatients who underwent surgery from June 2002 to May 2020 at a single tertiary center were included. Data was collected on patient demographics, clinical presentation, tumor histology, surgical procedures, and 30 day readmission and reoperation. Functional status was assessed using the Modified McCormick Scale (MMS) and queried preoperative neurological symptoms included weakness, urinary and bowel dysfunction, numbness, and back and radicular pain. Variables significant on univariable analysis at the α≤0.15 level were entered into a stepwise multivariable logistic regression model. RESULTSOf 235 included cases, 131 (56%) experienced a nonhome discharge and 68 (29%) experienced a prolonged LOS. Of 178 patients with ≥ 30 days of follow-up, 17 (9.6%) were readmitted within 30 days and 13 (7.4%) underwent reoperation. Wound dehiscence (29%) was the most common reason for readmission. Nonhome discharge was independently predicted by older age (OR=1.03/year; p<.01), thoracic location of the tumor (OR=2.36; p=.01), presenting with bowel dysfunction (OR=4.09; p=.03), and longer incision length (OR=1.44 per level; p=.03). Independent predictors of prolonged LOS included presenting with urinary incontinence (OR=2.65; p=.05) or a higher preoperative white blood cell count (OR=1.08 per 103/μL); p=.01), while GTR predicted shorter LOS (OR=0.40; p=.02). Independent predictive factors for 30 day unplanned readmission included experiencing ≥1 complications during the first hospitalization (OR=6.13; p<.01) and having a poor (A-C) versus good (D-E) baseline neurological status on the ASIA impairment scale (OR=0.23; p=.03). The only independent predictor of unplanned 30 day reoperation was experiencing ≥1 inpatient complications during the index hospitalization (OR=6.92; p<.01). Receiver operating curves for the constructed models produced C-statistics of 0.67-0.77 and the models were deployed as freely available web-based calculators (https://jhuspine5.shinyapps.io/Intramedullary30day). CONCLUSIONSWe found that neurological presentation, patient demographics, and incision length were important predictors of adverse perioperative outcomes in patients with IMSCTs. The calculators can be used by clinicians for risk stratification, preoperative counseling, and targeted interventions.

Association of early discharge with increased likelihood of hospital readmission in first four weeks for vaginally delivered neonates.

AimThe main aim was to determine whether hospital readmission rates by 28 days of age are elevated with early discharge (ED) in Finland. We sought to identify the causes and predictors of ED, readmission rates, admissions to the intensive care unit (ICU) and death.MethodsThe data of 333,321 infants were retrieved from nationwide registers. Vaginally delivered single infants at gestational ages (GAs) of ≥37+0, born in 2008–2015 and treated in any maternity ward in Finland, were included. ED was defined as discharge on the day of birth or after one night stay on the maternity ward.ResultsDuring the study period, the ED and hospital readmission rates increased. Low‐risk infants and those born in high population‐density areas were more likely to be discharged early. ED predicted hospital readmission but not ICU admission or death. The most common reason for readmission was jaundice, followed by infection. ED seemed not to predict severe cardiologic problems. Rather than ED, being born at 38+0–38+6 weeks’ GA significantly predicted ICU admission or death.ConclusionEarly discharge seems to be associated with increased hospital readmission. Birth at 38+0–38+6 weeks’ GA was a significant predictor of ICU admission or death, as opposed to early discharged infants.

Short-Term Readmission Following Community-Acquired Pneumonia: A Cross-Sectional Study.

Background:Community-acquired pneumonia continues to be a major cause of morbidity and mortality. Hospital readmissions following community-acquired pneumonia are linked to significant cost of care and medical burdens. This study aimed to determine the incidence and reasons for readmission as well as to assess factors associated with short-term hospital readmission among community-acquired pneumonia patients. Methods:A retrospective, cross-sectional study was conducted on 582 medical records of community-acquired pneumonia inpatients from December 2018 to December 2019 at an 800-bed tertiary hospital in Ho Chi Minh City, Vietnam. We collected data on patient characteristics, pneumonia severity at hospital admission, microbiology and antibiotic resistance, appropriateness of empiric antibiotic therapies, and the readmissions information. Multivariable logistic regression analyses were performed to identify factors associated with 30-day hospital readmission. Results: Of the 582 hospitalized community-acquired pneumonia patients, 11.9% were readmitted to the hospital within 30 days. About half of the cases (43.5%) were due to pneumonia. Multidrug-resistant bacteria accounted for 43.2% of the pathogen isolates. A high Charlson comorbidity index (aOR, 1.40; CI 95%, 1.08-1.82) and multidrug-resistant infection (aOR, 2.63; CI 95%, 1.05-6.56) were associated with higher odds of all-cause readmission. Conclusions:Hospital readmissions within 30 days occurred frequently among community-acquired pneumonia inpatients, and the most common reason for readmission recorded was pneumonia-related. Monitoring closely patients with multimorbidity or multidrug-resistant infections may improve treatment outcomes.

Abstract WP82: Early Readmissions After Hospitalization For Posterior Reversible Encephalopathy Syndrome

Background: While most patients with posterior reversible encephalopathy syndrome (PRES) have clinical and radiological reversibility, a significant proportion can have residual neurologic sequelae and longstanding morbidity. The aim of the study was to evaluate the rate, etiologies, and risk factors for 90-day readmissions following hospitalization for PRES. Methods: Data were obtained from the Nationwide Readmissions Database 2016-2018. Hospitalizations with primary diagnosis of PRES, survival to discharge, and known discharge disposition were included in the study. Primary outcome was non-elective readmission within 90 days of discharge. Survival analysis was performed, and independent predictors of readmission were analyzed using multivariable Cox proportional hazards regression. P&lt;0.01 was considered significant. Results: There were 6,155 hospitalizations that met the study inclusion criteria (mean±SD age: 55.9±17.3 years, female: 71.0%). Non-elective readmission within 90 days of discharge occurred in 1,922 (31.2%) patients. The most common reasons for readmissions were infections (20.0%), hypertensive disorders (12.4%), fluid/electrolyte imbalance or renal problems (8.8%), gastrointestinal problems (7.2%), continued/recurrent symptoms related to PRES (6.3%), cardiac problems (5.5%), seizures (4.6%), and acute cerebrovascular events (4.4%). Age was inversely associated with risk of readmissions [hazards ratio (HR): 0.91 for every 10 years increase in age, 95% confidence interval (CI): 0.87-0.95, P &lt;0.001]. Patients with chronic kidney disease (HR: 1.24, 95% CI: 1.06-1.46, P 0.009) and higher Charlson comorbidity index score (HR: 1.10, 95% CI: 1.07-1.14, P &lt;0.001) were more likely to be readmitted. Further, patients with longer length of stay (HR: 1.01, 95% CI: 1.00-1.02, P 0.002) and those not discharged to home (HR: 1.35, 95% CI: 1.16-1.58, P &lt;0.001) during the index hospitalizations were also at a higher risk for readmission. Conclusions: Nearly one-third of patients with PRES get readmitted within 90 days of discharge. While most of the readmissions are due to non-neurologic etiologies, ongoing symptoms related to PRES, seizures, and acute cerebrovascular events contribute to about 15% of all readmissions.

The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study.

Background: Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. Methods: We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. Results: The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. Conclusions: UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.

Readmission of late preterm and term neonates in the neonatal period

ObjectiveTo determine the incidence of hospital readmissions in late preterm and term neonates, the most common reasons for readmission, and analyze the risk factors for readmission in the neonatal period. MethodsNewborn infants admitted to a well-baby nursery ≥ 36 weeks gestation were included in this retrospective cohort study. Data for all infants born in a 3-year period and readmitted in the first 28 days of life were analyzed. Indication for readmission was one diagnosed during initial workup in the pediatric emergency room visit before readmission. ResultsThe final cohort consisted of 5408 infants. The readmission rate was 4.0% (219/5408). Leading readmission causes were respiratory tract infection (29.58%), jaundice (13.70%), and urinary tract infection (9.59%). The mean ± SD age of readmitted infants was 13.3 ± 7.1 days. The mean ± SD treatment duration of treatment was 5.5 ± 3.0 days. In the multivariate regression analysis, infants that were during the initial hospitalization transferred to special care/NICU had a lower chance of readmission during the neonatal period (p = 0.04, OR = 0.23, 95% CI 0.06–0.93). Infants with mothers aged from 19–24 years had a higher risk of readmission (p = 0.005, OR = 1.62, 95% CI 1.16–2.26). ConclusionsFinding that infants that were during the initial hospitalization transferred to special care or a NICU setting were less likely to require hospitalization in the neonatal period is an interesting one. Further research into how different approach in these settings reduce the risk of readmission is necessary.