Comparison Of Readmission Research Articles

A case-control study comparing rates and diagnoses of hospital readmission in infants affected by neonatal abstinence syndrome

Objective Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016–2020). Methods Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis. Results Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p = .007) and those infants residing in rural areas (OR = 1.9; p < .001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders). Conclusions Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected.

A Comparison of Re-admission and Emergency Department Visits in a Colorectal Surgical Home versus Traditional Perioperative Care

A Comparison of Re-admission and Emergency Department Visits in a Colorectal Surgical Home versus Traditional Perioperative Care

Comparison of readmission and complication rates between traditional sleep surgery and hypoglossal nerve stimulation.

ObjectiveThis study aims to compare readmission and complication rates between hypoglossal nerve stimulation (HNS) and traditional sleep surgery (TSS) in the 90‐day postoperative period using a federated electronic health record (EHR) database.MethodsWe queried TriNetX, a global federated health research network providing access to EHR data from approximately 70 million patients in 49 large health care organizations to identify individuals who underwent either HNS or TSS for obstructive sleep apnea (OSA) from April 2014 to March 2021. Propensity scores based on demographics and obesity were used to balance groups. We compared the frequency of readmission/representation and surgical‐related complication rates between cohorts.ResultsAfter propensity score matching of HNS versus palatal surgery (n = 1014 in each cohort) and HNS versus multilevel surgery (n = 374 in each cohort), we found palatal and multilevel surgery had a significantly higher risk of readmission versus HNS. (12% vs. 4%, p < .0001). Palatal surgery complication rate was also higher than HNS (21% vs. 2%, p < .0001). Multi‐level surgery results were similarly higher (22% vs. 3%, p < .001). The most common diagnoses at ER readmission for TSS were procedural complications and pain, while common diagnoses for HNS readmission were general complaints such as malaise and headache.ConclusionsHypoglossal nerve stimulation has lower risk of readmission and postoperative complications than traditional sleep surgery as demonstrated in a large research network database analysis. Level of Evidence: 3.

1050-P: Rates, Characteristics, and Comparison of Readmissions for Diabetic Ketoacidosis in Patients with Psoriasis in the United States: A National Population-Based Study

Introduction: Psoriasis is known to increase the risk of type 1 diabetes mellites. This study aims to compare rates and outcomes of 30-day readmissions following admissions for type 1 diabetic ketoacidosis (T1DKA) in patients with and without psoriasis in the United States. Methods: We analyzed the 2018 National Readmission Database. We included index hospitalizations for all patients (aged≥18 years) with a principal diagnosis of T1DKA using ICD-10 codes. We further sub-stratified this group into those with and with a secondary diagnosis of psoriasis. Chi-square tests and regression analysis were used to compare 30-day readmission rates and readmission outcomes between both groups. We excluded elective and traumatic readmissions. Results: A total of 94,461 index hospitalizations for T1DKA, that were discharged alive, were included in the analysis. 357 (0.4%) of these, had co-existing psoriasis. 15,614 (16.5%) readmissions occurred within 30 days. Readmission rates were similar between psoriasis and non-psoriasis group (15.0% vs. 16.5%, p=0.663). The psoriasis group had a similar mean hospital length of stay (3.3 days vs. 2.9 days, p=0.077) and total hospital costs ($8,435 vs. $7,231, p=0.055) compared to the non-psoriasis group. Readmissions for T1DKA in psoriasis patients was associated with a total of 1,191 hospital days and $3,014,844 in-hospital costs. T1DKA without coma was the most common reason for readmission in both groups. Conclusion: Psoriasis patients admitted for T1DM have similar 30-day readmission rates and readmission outcomes compared to non-psoriasis patients admitted for TIDM. Disclosure E. Edigin: None. P. E. Ojemolon: None. H. Shaka: None. P. O. Eseaton: None. M. Almani: None. D. Jakhar: None. I. R. Asemota: None. E. Akuna: None.

Is outpatient shoulder arthroplasty safe in patients aged ≥65 years? A comparison of readmissions and complications in inpatient and outpatient settings.

Recent studies indicate that outpatient total shoulder arthroplasty (TSA) is cost-effective and may have a low complication rate similar to inpatient TSA. However, existing studies have included younger patient cohorts who typically possess fewer medical comorbidities. Patients aged ≥65 years are commonly enrolled in Medicare, which has traditionally designated TSA as an inpatient-only procedure. The purpose of this study was to compare surgical complication rates and 90-day readmission rates between inpatient and outpatient TSA performed in adults aged ≥65 years. Medical records for all patients aged ≥65 years who underwent primary anatomic or reverse TSA by a single surgeon from July 2015 to May 2020 were reviewed. Patients were preselected for outpatient or inpatient surgery based on lack of significant cardiopulmonary comorbidities and patient preference. Demographics, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were collected in addition to emergency department (ED) visits and readmissions within 90 days of the index surgery. Relationships among frequency and types of complications and surgical setting (inpatients vs. outpatient) were assessed. Complication rates and demographic variables between inpatient and outpatient procedures were compared. Logistic regressions were performed to account for interacting predictor variables on the odds of having complications. A total of 145 shoulders (138 patients; 95 male, 43 female) were included in the analysis, of which 98 received inpatient TSA and 47 received outpatient TSA. Average age was 75.5 ± 7.2 for inpatient TSA and 70.5 ± 4.5 for outpatient TSA (P < .001). Patient age (P < .001), ASA score ≥3 (P < .001), and reverse TSA (P = .002) were significantly positively correlated with receiving inpatient surgery. There were 16 complications (16.3%) in the inpatient group and 9 complications (19.1%) in the outpatient group (P = .648). There were no significant differences in the frequency of postoperative complications, return to the ED, or reoperations between inpatient and outpatient procedures (P > .05). Each 1-year increase in age increased the predicted odds of having a surgical complication by 14% (odds ratio = 1.14; P = .021), irrespective of surgical setting. Those who underwent inpatient TSA had a significantly higher frequency of 90-day readmission (inpatient=16, outpatient=1; P = .034). Postoperative complications and ED returns were not significantly different between inpatient and outpatient TSA. Each 1-year increase in age increased the odds of postoperative surgical complications by 14%, regardless of surgical setting. Outpatient TSA was found to be safe for appropriately selected patients aged ≥65 years, and re-evaluation of TSA as an inpatient-only procedure should be considered.

Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database.

BackgroundAfter release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost.MethodsWe utilized the 2013 Nationwide Readmission Database (NRD) to examine national readmission and revision rates, the reasons for revision procedures, and associated costs for elective TKA procedures. As data are not linked across years, we examined revision rates for TKA completed in the month of January by capturing revision procedures in the subsequent following 11-month period to approximate a 1-year revision rate. Diagnosis and procedure codes for revision procedures were collected. Average readmission and revision procedure costs were then calculated, and the cost distributed across the entire TKA population.ResultsWe identified 20,851 patients having TKA surgery. The mean unadjusted 30- and 90-day TKA readmission rates were 3.4% and 5.8%, respectively. In contrast, the mean unadjusted 3-month and approximate 1-year reoperation rates were 1.0% and 1.6%, respectively. The most common cause for revision was periprosthetic joint infection, which accounting for 62% of all reported revision procedures. The mean payment for 90-day readmission was roughly half ($10,589±$11,084) of the mean inpatient payment for single reoperation procedure at 90 days ($20,222±$17,799). Importantly, nearly half (46%) of all 90-day readmissions were associated with a reoperation event within the first year.ConclusionsReadmission following TKA is associated with a 1-year reoperation in approximately half of patients. These reoperations represent a significant patient burden and have a higher per episode cost. Early reoperation may represent a more clinically relevant target for quality improvement and cost containment.

Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States

Objectives To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013–30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. Results NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02–1.08; p < .001), MB-related (OR: 1.28; CI: 1.16–1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11–1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02–1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44–1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.

A comparison of readmission and complication rates and charges of inpatient and outpatient multiple-level anterior cervical discectomy and fusion surgeries in the Medicare population.

This study aims to assess the relationship of comorbidities and postoperative complications to rates of readmission for geriatric patients undergoing anterior cervical discectomy and fusion (ACDF) involving more than 2 levels on an inpatient or outpatient basis. With the rising costs of healthcare in the United States, understanding the safety and efficacy of performing common surgical interventions (including ACDF) as outpatient procedures could prove to be of great economic impact.Objective This study aims to assess the effect of comorbidities and postoperative complications on the rates of readmission of geriatric patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) procedures (i.e., ACDF involving 3 or more levels) on an inpatient or outpatient basis. Same-day surgery has been demonstrated to be a safe and cost-effective alternative to the traditional inpatient option for many surgical interventions. With the rising costs of healthcare, understanding the safety and efficacy of performing common surgical interventions as outpatient procedures could prove to be of great economic impact. The study population included total of 2492 patients: 2348 inpatients and 144 outpatients having ACDF procedures involving 3 or more levels in the Medicare Standard Analytical Files database. Age, sex, comorbidities, postoperative complications, readmission rates, and surgical procedure charges were compared between both cohorts. For selected variables, logistic regression was used to model odds ratios for various comorbidities against readmission rates for both inpatient and outpatient cohorts. Chi-square tests were also calculated to compare these comorbidities with readmission in each cohort. Overall complication rates within 30 postoperative days were greater for inpatients than for outpatients (44.2% vs 12.5%, p < 0.001). More inpatients developed postoperative urinary tract infection (7.9% vs 0%, p < 0.001), and the inpatient cohort had increased risk of readmission with comorbidities of anemia (OR 1.52, p < 0.001), smoking (OR 2.12, p < 0.001), and BMI ≥ 30 (OR 1.43, p < 0.001). Outpatients had increased risk of readmission with comorbidities of anemia (OR 2.78, p = 0.047), diabetes mellitus type 1 or 2 (OR 3.25, p = 0.033), and BMI ≥ 30 (OR 3.95, p = 0.008). Inpatients also had increased readmission risk with a postoperative complication of surgical site infection (OR 2.38, p < 0.001). The average charges for inpatient multilevel ACDF were significantly higher than for multilevel ACDF performed on an outpatient basis ($12,734.27 vs $12,152.18, p = 0.0019). This study suggests that ACDF surgery involving 3 or more levels performed as an outpatient procedure in the geriatric population may be associated with lower rates of readmissions, complications, and surgical charges.

Comparison of Readmission and Death Among Patients With Cardiac Disease in Northern vs Southern Ontario

BackgroundGeographic factors may influence cardiovascular disease outcomes in Canada. Circulatory diseases are a major reason for higher population mortality rates in Northern Ontario, but it is unknown if hospitalized patients with cardiovascular disease experience differential outcomes compared with those in the South. MethodsWe examined 30-day and 1-year mortality and readmissions for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), or stroke in Northern compared with Southern Ontario, using the Canadian Institute for Health Information Discharge Abstract Database (2005-2016). Northern patients were defined as those residing and hospitalized in the Northwest or Northeast Local Health Integration Network regions. We used multiple Cox proportional hazards regression analysis for time-to-first event and Prentice-Williams-Peterson method to evaluate repeat and multiply admitted patients. ResultsA total of 47,745 Northern and 465,353 Southern patients hospitalized with AMI (n = 182,158), HF (n = 130,770), AF (n = 72,326), or stroke (n = 127,844) were studied. Rates of first readmission were higher among Northern patients for AMI (adjusted hazard ratio [HR], 1.32), HF (HR, 1.16), AF (HR, 1.21), and stroke (HR, 1.27) compared with Southern patients (all P < 0.001). Repeat readmission rates among Northern patients for AMI (HR, 1.23), HF (HR, 1.13), AF (HR, 1.18), and stroke (HR, 1.22) were also increased (all P < 0.001 vs Southern). Thirty-day mortality did not differ significantly between Northern and Southern patients. ConclusionsReadmissions were increased in those residing and hospitalized in the North. To reduce readmissions in the North, the quality of postacute transitional care should be examined further.

710 - Comparison of readmissions and hospital costs between continent and incontinent urinary diversion after radical cystectomy: An analysis of a nationally representative database

710 - Comparison of readmissions and hospital costs between continent and incontinent urinary diversion after radical cystectomy: An analysis of a nationally representative database

Comparison of Readmission Causes and Rates in Patients Supported with an Axial versus Centrifugal Flow LVAD

Comparison of Readmission Causes and Rates in Patients Supported with an Axial versus Centrifugal Flow LVAD

Low ninety-day re-admission rates after emergency and elective laparoscopic cholecystectomy in a district general hospital

Re-admission rate following laparoscopic cholecystectomy is currently defined as within 30 days of the initial operation. This may underestimate the true incidence and financial cost of postoperative morbidity. This study aimed to analyse re-admissions within 90 days of elective and emergency laparoscopic cholecystectomy at a district general hospital, and to compare outcomes to larger teaching centres. We undertook a retrospective analysis of all patients re-admitted within 90 days of laparoscopic cholecystectomy during an 18-month period (June 2006 to December 2007). Patient characteristics, details of the primary operation, and reasons for re-admission were identified, and a comparison of re-admissions following elective versus emergency procedures was performed. A total of 326 laparoscopic cholecystectomies were performed during the 18-month period (246 elective, 80 emergency). No operations required conversion to an open procedure. Twenty-five patients were re-admitted within 90 days of their operation, of whom only 14 had complications directly related to their surgery (overall re-admission rate 4.3%). There was no statistical difference in re-admission rate or cause of re-admission between elective and emergency procedures. However, the mean time to re-admission following elective procedures was significantly longer (36 days; P = 0.0003). Re-admission rates at our district general hospital are comparable to those reported by larger teaching centres. Current 30-day re-admission data may significantly underestimate morbidity rates and socio-economic cost following elective laparoscopic cholecystectomy.