Early Readmission In Patients Research Articles

The burden and predictors of 30-day unplanned readmission in patients with acute liver failure: a national representative database study

BackgroundLiver diseases were significant source of early readmission burden. This study aimed to evaluate the 30-day unplanned readmission rates, causes of readmissions, readmission costs, and predictors of readmission in patients with acute liver failure (ALF).MethodsPatients admitted for ALF from 2019 National Readmission Database were enrolled. Weighted multivariable logistic regression models were applied and based on Directed Acyclic Graphs. Incidence, causes, cost, and predictors of 30-day unplanned readmissions were identified.ResultsA total of 3,281 patients with ALF were enrolled, of whom 600 (18.3%) were readmitted within 30 days. The mean time from discharge to early readmission was 12.6 days. The average hospital cost and charge of readmission were $19,629 and $86,228, respectively. The readmissions were mainly due to liver-related events (26.6%), followed by infection (20.9%). The predictive factors independently associated with readmissions were age, male sex (OR 1.227, 95% CI 1.023–1.472; P = 0.028), renal failure (OR 1.401, 95% CI 1.139–1.723; P = 0.001), diabetes with chronic complications (OR 1.327, 95% CI 1.053–1.672; P = 0.017), complicated hypertension (OR 1.436, 95% CI 1.111–1.857; P = 0.006), peritoneal drainage (OR 1.600, 95% CI 1.092–2.345; P = 0.016), etc.ConclusionsPatients with ALF are at relatively high risk of early readmission, which imposes a heavy medical and economic burden on society. We need to increase the emphasis placed on early readmission of patients with ALF and establish clinical strategies for their management.

Abstract 12544: Point-of-Care Ultrasound Estimation of Right Atrial Pressure Predicts Early Readmission in Patients With Acute Decompensated Heart Failure

Introduction: We previously developed and validated a highly accurate non-invasive, point-of-care ultrasound (POCUS) technique that uses right internal jugular vein (RIJV) compliance to predict elevated right atrial pressure (RAP). We sought to determine whether this POCUS technique would predict 30-day readmission in acute decompensated heart failure (ADHF) patients. Hypothesis: POCUS-based estimation of RAP at the time of discharge can predict 30-day readmission in patients with ADHF. Methods: In this prospective cohort study, consecutive patients admitted with ADHF were screened for eligibility. POCUS images of the RIJV at end-expiration and at maximal expansion during Valsalva were collected daily during the patient’s stay. To assess compliance, the change in cross-sectional area (CSA) of the RIJV induced by Valsalva was calculated using ImageJ and referred to as the distensibility index (DI). From ROC analysis, a DI≥66% was considered negative for elevated RAP while a DI<66% was considered positive (PPV 87%). 30 days post-discharge, readmission data were collected from patients’ EMR and a follow-up phone call. Sensitivity/specificity and predictive value analyses were conducted based on readmission data for those discharged with positive and negative tests. Results: A total of 237 admitted patients were eligible for this analysis. Patients discharged with a POCUS-estimated elevated RAP had a 30 day readmission rate 3.5 times greater than those discharged with normal POCUS-estimated RAP (26.7% vs 7.6%). POCUS-based normal RAP at discharge had a 92.4% negative predictive value (NPV) for avoiding 30-day readmission (P<.001). A subset of patients in this cohort (n=81) were admitted to a local community hospital. In this setting, POCUS estimation of RAP at discharge had a 95.7% NPV (P<.001) for avoiding 30-day readmission, and patients discharged with a POCUS-based elevated RAP had a 30-day readmission rate 9.6 times greater than those discharged with a normal POCUS test (41.2% vs 4.3%) . Conclusions: POCUS estimation of RAP strongly predicts avoidance of 30-day readmission for ADHF. Using this technique to guide discharge planning, potentially to reduce readmission for ADHF, deserves further investigation in a prospective randomized trial.

WED-341 - The combination of LACE index, MELD on discharge and a previous history of decompensation defines risk groups for early readmission in patients with liver cirrhosis

WED-341 - The combination of LACE index, MELD on discharge and a previous history of decompensation defines risk groups for early readmission in patients with liver cirrhosis

498 An observational cohort study to examine SPUR, a patient-reported outcome measure of medication adherence, as a predictor of admission and early readmission in patients living with Type 2 Diabetes

Abstract Introduction Conservative estimates suggest that the cost of poor medication adherence (MA) to healthcare systems in the UK is close to £800Mn annually, however figures may be as high as £920Mn to £224Bn across larger parts of Europe and the US.(1) This may be attributed to the relationship between poor MA and an increased risk of hospital admission.(2) Often, cases are preventable and hence present an opportunity for avoidable costs if appropriately identified and managed, such as in the case of early readmissions (admissions occurring within 30 days of discharge). However, despite the association between MA and admissions, to date no predictive model has been developed that integrates a holistic Patient-Reported Outcome Measure (PROM) of MA. This study evaluated one such PROM, known as SPUR, as a predictor of general admission and early readmission in patients living with Type 2 Diabetes (T2D). Aim This study sought to develop a predictive model of early readmission and general admission risk using the SPUR tool as a PROM of MA in patients living with T2D. Methods Using an observational study design, 6-month retrospective and prospective patient monitoring were conducted to assess the number of admissions and early readmissions during the observational period. Outcomes were reported as binary and count variables. Patients were previously recruited from a large London NHS Trust as part of a cross-sectional study to validate SPUR. Covariates of interest included: age, ethnicity, gender, education level, income, the number of medicines and medical conditions, and Covid-19 diagnoses. A Poisson or negative binomial model was employed for count outcomes, with the exponentiated coefficient indicating incident ratios (IR) [95% CI]. For binary outcomes (Coefficient, [95% CI]), a logistic regression model was developed. Results Data were available for 200 patients. The modal age range was 70-79 years (n=74/200, 37.0%). Most participants were GCSE educated (42.5%), white (76.0%), and over a third female (36.0%) identified as female. For general admission risk as a count variable, a higher SPUR score (increased adherence) was significantly associated with a lower number of admissions (IR = 0.98, [0.96, 1.00]). Other factors associated with an increased risk of admission included: age ≥80 years (IR = 5.18, [1.01, 26.55]), GCSE education (IR = 2.11, [1.15 – 3.87]), number of medical conditions (IR = 1.07, [1.01, 1.13]), and a positive Covid-19 diagnosis during follow-up (IR = 1.83, [1.11, 3.02]). SPUR remained significant when modelled as a binary variable (-0.048, [-0.094, -0.003]). For early readmission, only the SPUR score was significantly predictive of the outcome as a binary variable (-0.051, [-0.094, -0.007]), indicating that those with a higher SPUR score were at less risk of an early readmission. Conclusion The study successfully developed a predictive model for both general admission and early readmissions in patients living with T2D using the SPUR tool and several covariates of clinical relevance. However, a small sample size is noted as a limitation. Future work may look to integrate SPUR as a holistic PROM of MA to support the development of tailored interventions to reduce patients’ risk of admission.

SPUR: A Patient-Reported Medication Adherence Model as a Predictor of Admission and Early Readmission in Patients Living with Type 2 Diabetes.

Poor medication adherence (MA) is linked to an increased likelihood of hospital admission. Early interventions to address MA may reduce this risk and associated health-care costs. This study aimed to evaluate a holistic Patient Reported Outcome Measure (PROM) of MA, known as SPUR, as a predictor of general admission and early readmission in patients living with Type 2 Diabetes. An observational study design was used to assess data collected over a 12-month period including 6-month retrospective and 6-month prospective monitoring of the number of admissions and early readmissions (admissions occurring within 30 days of discharge) across the cohort. Patients (n = 200) were recruited from a large South London NHS Trust. Covariates of interest included: age, ethnicity, gender, level of education, income, the number of medicines and medical conditions, and a Covid-19 diagnosis. A Poisson or negative binomial model was employed for count outcomes, with the exponentiated coefficient indicating incident ratios (IR) [95% CI]. For binary outcomes (Coefficient, [95% CI]), a logistic regression model was developed. Higher SPUR scores (increased adherence) were significantly associated with a lower number of admissions (IR = 0.98, [0.96, 1.00]). The number of medical conditions (IR = 1.07, [1.01, 1.13]), age ≥80 years (IR = 5.18, [1.01, 26.55]), a positive Covid-19 diagnosis during follow-up (IR = 1.83, [1.11, 3.02]) and GCSE education (IR = 2.11, [1.15,3.87]) were factors associated with a greater risk of admission. When modelled as a binary variable, only the SPUR score (-0.051, [-0.094, -0.007]) was significantly predictive of an early readmission, with patients reporting higher SPUR scores being less likely to experience an early readmission. Higher levels of MA, as determined by SPUR, were significantly associated with a lower risk of general admissions and early readmissions among patients living with Type 2 Diabetes.

Predictors of early hospital readmission in patients receiving home mechanical ventilation

BackgroundAlthough the proportion of patients with chronic respiratory failure requiring home mechanical ventilation (HMV) is increasing, hospital readmissions in these patients are also increasing. ObjectiveWe investigated the factors for early readmission in patients receiving HMV. MethodsWe retrospectively analyzed the data of adult patients readmitted to the hospital within a year who first received HMV and were discharged from the Asan Medical Center between March 2014 and February 2019. We compared the clinical characteristics at discharge before readmission between the early (readmission within 30 days) and late readmission groups (readmission between day 31 and 1 year) and investigated the clinical characteristics and outcomes at readmission. ResultsOf the 116 patients identified, 36.2% had been readmitted early. The patients who received invasive HMV had a higher rate of early readmission than those who received non-invasive HMV. Pneumonia was the most common reason of readmission in the two groups. The rate of aspiration was significantly higher in the early readmission group (28.6% vs. 8.1%; P = .003). In multivariate logistic regression analysis, nasogastric tube feeding, sequelae of pneumonia or acute respiratory distress syndrome, and central nervous system disorders as causes for HMV were significantly associated with early readmission. ConclusionFeeding methods and causes for HMV were associated with early readmission. Educating caregivers on respiratory care (suction and feeding methods) is important for preventing early readmission.

Determination of factors associated with early readmission of patients with mental illness in two cities in Colombia during 2018

IntroductionEarly rehospitalisation in mental health units (SMHUs) is when a patient needs to be readmitted in the first 30 days after receiving discharge, and is mainly due to recurrent decompensation of their mental illness. This phenomenon is related to a worse prognosis and has an impact on the family, social and work environment. Absenteeism from work and additional hospital time are expenses for the health and employment system which have made rehospitalisation a phenomenon of special interest. The present study was carried out with the objective of exploring the factors associated with the readmission of patients with psychiatric illnesses treated in two MHUs during 2018, as well as those modifiable factors that act as protection for this condition. MethodsObservational, descriptive study with analytical component of cases and controls in two MHUs in different cities of Colombia. Information was obtained by collecting data from the medical records of patients who were admitted between 1 January 2018 and 31 December 2018. The data were collected between 20 February and 27 May 2019. The sample was composed of all the patients who met the criteria for early readmission in both institutions. The study group consisted of 113 patients: (28 cases and 85 controls), matched by by the variables: age, sex, place of hospitalisation and diagnosis. ResultsIn the two hospital MHUs the diagnoses found were: depression (15.5%), bipolar affective disorder (33.1%) and schizophrenia (37.3%). In Bogotá, the most prevalent was depression (31.1%) and, in Tunja, it was schizophrenia (44.8%). For both institutions, the factor most associated with readmission was alcohol consumption, but other variables of treatment, family nucleus, and individual intervention were also associated with a greater probability of early readmission. ConclusionsIt was possible to demonstrate that the use of atypical and/or depot antipsychotics, hospitalisations longer than 15 days, and prescriptions of less than three drugs at discharge, reduce the number of early readmissions to MHUs.

Predictors for early readmission in patients hospitalized with new onset pediatric lupus nephritis.

The objective is to determine the 30-day hospital readmission rate following a hospitalization due to pediatric lupus nephritis of recent onset and characterize the risk factors associated with these early readmissions. The study included 76 children hospitalized from 01/01/2008 to 4/30/2017 due to a new diagnosis of lupus nephritis. We calculated the 30-day hospital readmission rate and compared the characteristics of the patients that were readmitted to patients that were not readmitted using univariable and multivariable analysis. The 30-day readmission rate was 17.1%. Factors that predicted hospital readmission in unavailable analysis were male gender (38.5 vs 14.3%, p = 0.04), not receiving pulse steroids (30.8 vs 3.2%, p = < .001), receiving diuretic treatment (69.2 vs 34.9%, p = .02), receiving albumin infusions (46.2 vs 12.7%, p = .004), stage 2 hypertension on day one of admission (76.9 vs 41.3%, p = .02), a higher white blood cell count on discharge (13.7 × 103/mm3 vs 8.8 × 103/mm3, p = .023), need for non-angiotensin converting enzyme (ACE) antihypertensive drugs (76.9 vs 46%, p = .042), and being discharged on nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1 vs 4.8%, p = .025). Multivariable analysis demonstrated an increased risk of readmission for patients not treated with intravenous pulse methylprednisolone (IVMP) (OR = 17.5 (1.81-168.32) p = .013), and for those who required intravenous albumin assisted diuresis for hypervolemia (OR=6.25 (1.29-30.30) p = .022). In all, 17% of children hospitalized due to new onset lupus nephritis were readmitted within 30days of discharge. Absence of IVMP and receiving intravenous albumin assisted diuresis during initial hospitalization increase the risk of early readmission in new onset pediatric lupus nephritis.

Predicting Early Readmission of Patients with Rib Fractures

Bolourani, Siavash MD; Kyaw, Crystal MD; Wang, Ping MD; Jeschke, Marc G. MD, FACS; Coppa, Gene F. MD, FACS; Patel, Vihas MD; Daniel Giangola, Matthew MD Author Information

Early Hospital Readmission in Patients With Tuberculosis: Social and Cultural Risk Factors

Background: Few studies have focused on risk factors for early readmission in patients with tuberculosis. Objective: Determine what are the risk factors for the early readmission of patients with tuberculosis at General Tijuana Hospital, Mexico. Material and methods: All patients aged ≥ 18 years who were admitted with the confirmed diagnosis of pulmonary tuberculosis were prospectively included. Information was obtained on demographic, socioeconomic variables, previous hospitalizations, clinical data, and laboratory and radiographic studies. Results: One hundred and thirty-four patients with tuberculosis were included, and 24 of them (17.9%) corresponded to early hospital readmissions. The interval between initial admission and readmission was 1.45 ± 0.183 months. The readmission group had used illicit drugs for more years (11.3 ± 13.9 years) than the new cases group (8.01 ± 8.25 years; p = 0.03). Forty percent of the patients who were readmitted did not go to their referral health unit after their initial hospital discharge. The reasons argued by the patients included, among others, not having received information regarding their illness during hospitalization, the abuse of illegal substances and the perception of hostility by health personnel. Discussion: One out of every five patients admitted for tuberculosis will be readmitted after only six weeks of initial discharge. Sociocultural factors (addictions, comorbidities, poverty) and of the health system (limited hours of medical care, accessibility) contribute to this phenomenon. Conclusions: Loss of follow-up after hospital discharge is common in most settings and contributes to an increase in morbidity and mortality, and transmission of infection in the community.

Subtle changes of serum creatinine and C-reactive protein during the index hospitalization predict early readmission in patients with decompensated cirrhosis

Subtle changes of serum creatinine and C-reactive protein during the index hospitalization predict early readmission in patients with decompensated cirrhosis

Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study.

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.

Subtle changes of c-reactive protein and serum creatinine during the index hospitalization predict early readmission in patients with decompensated cirrhosis

Background/Aims: Patients with decompensated cirrhosis had a high risk of early re-hospitalization. This study aims at identifying new predictive factors and the prognostic impact of readmission within 30 days (early readmission) after discharge from an index hospitalization for acute decompensation (AD).

83 The Pancreatitis Activity Scoring System Predicts Post-Intervention Outcomes and Early Readmission in Patients With Infected Pancreatic Necrosis

INTRODUCTION: The Pancreatitis Activity Scoring System (PASS) score comprises of five weighted components (organ failure, SIRS, abdominal pain, opiate requirement, and oral intake), and has been externally validated to predict readmission and development of moderate to severe acute pancreatitis (AP). Our aim was to study the predictive role of PASS score (PS) in patients with suspected or confirmed infected pancreatic necrosis (IPN). METHODS: Consecutive inpatients with IPN requiring intervention treated at UCSF January 2011 through January 2019 were identified. PSs were calculated at admission, prior to and 72-hours after each intervention, and at discharge. Multivariable logistical regression was used to assess the relationship between PS and various outcomes; development of multi-organ failure (MOF), need for early re-intervention (&lt;1 week) and 30-day readmission. RESULTS: 67 patients (median age 54) were identified; organ failure rates were 55% respiratory, 60% shock, and 72% renal. Median admission PS was 440 (IQR 345–605). 38 patients underwent surgical therapy and 29 underwent step-up endoscopic therapy; median admission PSs were similar (405 vs 460, P = 0.62). A 20% reduction in the baseline PS at 72 hours post-intervention was associated with a lower rate of MOF development (aOR 0.01; 95% CI: 0.001–0.13, P &lt; 0.001) and early re-intervention (aOR 0.03; 95% CI: 0.003–0.16, P &lt; 0.001). The 72-hour post-intervention PS (AUC = 0.88) was superior to admission PS, post-intervention SIRS or pain score (AUC = 0.66, 0.51, 0.43, respectively P &lt; 0.001) for the prediction of development of MOF. Discharge PS &lt; 250 was associated with 89% lower odds of 30-day readmission (aOR 0.11; 95% CI: 0.03–0.46, P = 0.002) and the discharge PS (AUC = 0.88, Figure 1) had superior prediction of readmission compared to discharge pain or admission PASS scores (AUC = 0.66 and 0.60, respectively P &lt; 0.001). CONCLUSION: In this retrospective cohort study, the PASS score was associated with post-intervention clinical outcomes and early readmission suggesting it is a valid measure of disease activity in patients with infected pancreatic necrosis. Prospective studies are needed to further validate these results.

Predictors of 30-day rehospitalization in a sample of hospitalized patients with Bipolar I disorder

The transition from psychiatric hospitalization to home is marked by high clinical vulnerability, characterized by risk of symptom rebound, exposure to preexisting stressors, and challenges with outpatient treatment linkage. Rates of rehospitalization during this post-discharge period, particularly for those with bipolar disorder, are reported to be high. This study evaluated demographic and clinical predictors of early rehospitalization (within 30 days) in a sample of hospitalized adults with Bipolar I disorder (BD-I). A chart review was conducted for 215 patients with BD-I admitted to an academically-affiliated psychiatric hospital within one calendar year. A computer algorithm was used to extract relevant demographic, clinical, and treatment information. Univariate and multivariate logistic regression models were used to examine predictors of early rehospitalization. Overall, 12% of participants were readmitted within 30 days of discharge. Controlling for other clinical and demographic variables, patient functioning and pre-admission psychiatric polypharmacy, but not comorbid psychiatric diagnoses, predicted early readmission in patients with BD-I. Findings highlight the relative importance of considering low psychosocial functioning, and medication regimens containing multiple psychiatric medications, during hospitalizations. These features may indicate a subset of patients with BD-I who require more comprehensive discharge planning and support to transition to the community following a psychiatric hospitalization.

Early hospital readmission and survival in patients with cirrhosis: A population-based study.

Readmission in patients with cirrhosis is common. We aimed to determine the association between early hospital readmission and survival in the general population of patients with cirrhosis. This retrospective cohort study used routinely collected health care data from Ontario. We identified adults with cirrhosis using a validated case definition, and included those with at least one hospital admission between 1992 and 2016 resulting in discharge. Patients were classified into two groups based on timing of readmission after index admission: 1) ≤90 days, or 2) >90 days or no readmission. We described overall survival (OS) 90 days after the index hospitalization by readmission status using Kaplan-Meier curves and the log-rank test. The association between readmission and OS was evaluated using a multivariate Cox proportional hazards regression model. Our study included 115,081 patients. The median OS was shorter in patients readmitted in ≤90 days (4.1 years, IQR 0.9, 13.1) compared with those readmitted in >90 days or not readmitted during the study period (9.6 years, IQR 3.2, 21.9, p <0.001). Adjusting for potential confounders, those readmitted in ≤90 days had a higher hazard of death than those not readmitted (hazard ratio [HR] 1.56, 95% CI 1.53 to 1.59, p <0.001). Early readmission in patients with cirrhosis is a strong predictor of decreased OS. Our results suggest that patients with cirrhosis who have an early readmission should be further studied to determine whether this risk is modifiable. They can also be used to discuss long-term prognosis with patients and family members.

Length of hospital stay and its impact on subsequent early readmission in patients with acute heart failure: a report from the WET-HF Registry.

Heart failure (HF) is characterized by frequent rehospitalization and prolonged hospital stay. Although length of stay has been used as a surrogate marker for hospital performance, its association with early rehospitalization remains unknown. We investigated their precise association using contemporary Japanese HF registry. We analyzed the 2785 acute HF patients who were registered in the West Tokyo Heart Failure registry and discharged or transferred to the recuperation facilities (mean age, 73.8 ± 13.5years; 60.8% were men). Median length of stay was 15days (interquartile range, 10-23days). One-hundred and fourteen patients (4.1%) were readmitted for worsening HF within 30days after discharge. Thirty-day risk-adjusted HF readmission after a shorter length of stay (1-12days; the lower tertile within the cohort) was higher than those after intermediate (13-19days; the middle tertile) [HR 1.71, 95% confidence interval (CI) 1.05-2.77]. Even after a longer length of stay, there tended to be a higher risk of 30-day HF readmission (HR 1.59, 95% CI 0.96-2.65). In conclusion, the Japanese acute HF patients had low rates of early-HF readmission after quite a long length of stay at urban tertiary care centers. Shorter length of stay was associated with increased rates of 30-day HF readmission, while longer length of stay also the same trended.Clinical Trial Registration: https://www.umin.ac.jp/icdr/index-j.html . Unique identifier: UMIN000001171.

A validated risk model for prediction of early readmission in patients with hepatic encephalopathy

Introduction and aimHepatic encephalopathy (HE) is a common complication in cirrhotics and is associated with an increased healthcare burden. Our aim was to study independent predictors of 30-day readmission and develop a readmission risk model in patients with HE. Secondary aims included studying readmission rates, cost, and the impact of readmission on mortality. Materials and methodsWe utilized the 2013 Nationwide Readmission Database (NRD) for hospitalized patients with HE. A risk assessment model based on index hospitalization variables for predicting 30-day readmission was developed using multivariate logistic regression and validated with the 2014 NRD. Patients were stratified into Low Risk and High Risk groups. Cox regression models were fit to identify predictors of calendar-year mortality. ResultsOf 24,473 cirrhosis patients hospitalized with HE, 32.4% were readmitted within 30 days. Predictors of readmission included presence of ascites (OR: 1.19; 95% CI: 1.06–1.33), receiving paracentesis (OR: 1.43; 95% CI: 1.26–1.62) and acute kidney injury (OR: 1.11; 95% CI: 1.00–1.22). Our validated model stratified patients into Low Risk and High Risk of 30-day readmissions (29% and 40%, respectively). The cost of the first readmission was higher than index admission in the 30-day readmission cohort ($14,198 vs. $10,386; p-value <0.001). Thirty-day readmission was the strongest predictor of calendar-year mortality (HR: 4.03; 95% CI: 3.49–4.65). ConclusionsNearly one-third of patients with HE were readmitted within 30 days, and early readmission adversely impacted healthcare utilization and calendar-year mortality. With our proposed simple risk assessment model, patients at high risk for early readmissions can be identified to potentially avert poor outcomes.

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database.

Early readmission in patients with decompensated liver cirrhosis leads to an enormous burden on health care use. A retrospective cohort study using the 2013 and 2014 Nationwide Readmission Database (NRD) was conducted. Patients with a diagnoses of cirrhosis and at least one feature of decompensation were included. The primary outcome was to develop a validated risk model for early readmission. Secondary outcomes were to study the 30-day all-cause readmission rate and the most common reasons for readmission. A multivariable logistic regression model was fit to identify predictors of readmissions. Finally, a risk model, the Mumtaz readmission risk score, was developed for prediction of 30-day readmission based on the 2013 NRD and validated on the 2014 NRD. A total of 123,011 patients were included. The 30-day readmission rate was 27%, with 79.6% of patients readmitted with liver-related diagnoses. Age <65 years; Medicare or Medicaid insurance; nonalcoholic etiology of cirrhosis; ≥3 Elixhauser score; presence of hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma, paracentesis, or hemodialysis; and discharge against medical advice were independent predictors of 30-day readmission. This validated model enabled patients with decompensated cirrhosis to be stratified into groups with low (<20%), medium, (20%-30%), and high (>30%) risk of 30-day readmissions. Conclusion: One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of a simple risk scoring model with high generalizability, based on demographics, clinical features, and interventions, can bring refinement to the prediction of 30-day readmission in high-risk patients; the Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population.

SPEAR: STUDY OF PATIENTS WITH PARA-PNEUMONIC PLEURAL EFFUSION WHO ARE RE-ADMITTED WITHIN 30 DAYS

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Parapneumonic pleural effusions (PPE) pose a significant risk of morbidity and mortality in patients admitted with pneumonia. There are limited data on readmissions in such patients. Readmission rate is an important healthcare quality metric. We sought to determine the rate of 30-day readmissions following an index admission for PPE and the major causes and in-hospital mortality in such cases. METHODS: This is a retrospective cohort study using the 2014 National Readmission Database (NRD). Adults admitted with a primary diagnosis of pneumonia complicated by pleural effusion were included. Patients with primary diagnosis of lung cancer and heart failure, those who died during index admission and inter-hospital transfers were excluded. ICD 9 codes were used to identify all diagnoses. RESULTS: A total of 10,167 index admissions were identified with primary diagnosis of PPE between January to November of 2014. After excluding 364 patients (3.6%) who died during the index admission, 9803 patients were included in the readmission analysis. Of these, 1,313 (13.4%) were re-admitted within 30 days. The average age of these patients was 68.4 years and half were women. The most common causes of readmission were pneumonia (15.5%) and pleural effusion including empyema (13%). Other causes included sepsis (9.7%), heart failure (7.1%) and respiratory failure (3.9%). The in-hospital mortality was 9%, which is higher compared to the index admission (3.6%). CONCLUSIONS: There is a major risk of 30-day readmissions in patients admitted with PPE. Major causes of readmissions were respiratory including pneumonia and pleural effusion. CLINICAL IMPLICATIONS: There is a need to identify predictors of early re-admission in patients with PPE. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Naveen Premnath, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Karan Sud, source=Web Response