Etiology Of Readmissions Research Articles

Readmission rate among survived patients with acute respiratory failure: 1-year study

ContextCritically ill patients, especially those with respiratory failure associated with multiple comorbidities, are at risk of recurrent ICU admission and consuming a significant portion of medical resources.AimTo study the risk factors and common etiologies of readmission among surviving patients with acute respiratory failure in Mansoura University’s respiratory intensive care unit during the year 2023.Settings and designThis was a retrospective cohort study.Patients and methodsThis study included all patients with acute respiratory failure who were admitted to Mansoura University’s respiratory intensive care unit (RICU), from January 2023 to December 2023. Deceased patients after initial admission or those with incomplete data were not included in the study. All data related to patient’s demographics, type of respiratory failure, type of respiratory support, associated comorbidities, length of ICU stay, and causes of readmission were collected from the registration system database.ResultsEight-hundred-thirty (830) cases that were admitted to the Mansoura University’s RICU with respiratory failure in the year 2023 were enrolled in the study, and 84 cases (10.1%) of them were readmitted. COPD exacerbation was the most common cause of readmission (35.7%) followed by pneumonia (21.4%) and OSA exacerbation (20.2%). Results showed that the significant independent predictors of readmission were being male [AOR (95% CI): 1.8 (1.01–3.1), p: 0.046], having organ failure (renal/liver) [AOR (95% CI): 29.9 (7.9–113.4), p ≤ 0.001], and length of ICU stay more than 12 days [AOR (95% CI): 4.8 (2.6–8.6), p ≤ 0.001]. Also, the type of respiratory failure and the type of respiratory support received were significantly associated with readmission in the univariate analysis; however, they were insignificant in the multivariate analysis.ConclusionThe rate of readmission was not high (only 10.3%). The most common causes of readmission were COPD exacerbation, followed by pneumonia and OSA exacerbation, respectively. Type of respiratory failure, male gender, the presence of other organ failure, and length of ICU stay are significant independent predictors of readmission in Mansoura University’s RICU during the year 2023. Therefore, higher-risk individuals should receive attention and careful assessment before discharge from the ICU to reduce the rate of readmission.Trial registrationClinicalTrials.gov identifier: NCT06291636.

HOSPITAL READMISSION AND MORTALITY RATES IN PATIENTS WITH CONCURRENT DEPRESSION AND INFLAMMATORY BOWEL DISEASE: INSIGHTS FROM THE NATIONAL READMISSIONS DATABASE, 2016–2019

Abstract BACKGROUND Inflammatory Bowel Disease (IBD) is a proinflammatory condition that is known to be associated with depression. Research examining causality suggests that Crohn's disease (CD) or ulcerative colitis (UC) patients are vulnerable to triggering pre-existing mental health conditions and that conversely, a pre-existing disorder such as depression may have an effect on the disease process and course of IBD. There is a paucity of comprehensive studies examining the downstream effects of depression on patients with IBD such as readmission rates and mortality. The complexity of the interaction between depression and IBD remains a fertile ground for further investigations in terms of pathological reciprocity and downstream consequences. METHODS In this retrospective observational study, patients were queried from the National Readmissions Database from 2016 to 2019. ICD-10 codes were used to identify patients with Crohn’s disease, ulcerative colitis, and depression. Primary outcomes were mortality and readmission rates at 30 days and 90 days. Secondary outcomes were index admission mortality, hospital length of stay (LOS), and total hospitalization charges (TOTHC) at 30 and 90 days respectively. The top 10 readmission diagnoses in each subgroup were also identified. RESULTS For patients with CD and depression, the mean age at readmission was 51.6 years with a high readmission and mortality rate at 30 days (readmission rate 5.2%, p<0.01; mortality rate 2.8%, p<0.01) which increased significantly at 90 days (readmission rate 8.4%, p<0.01). Hospital LOS and TOTHC remained relatively the same compared to the index admission for both 30-day and 90-day readmissions (Table 1,2). A similar trend was seen for UC and depression as well: mean age at readmission was 51.4 years with a high readmission rate and mortality at 30 days (readmission rate 5.0%, p<0.01; mortality rate 2.6%, p<0.01) which increased significantly at 90 days (readmission rate 8.4%, p<0.01; mortality rate 2.9%, p<0.01). Sepsis, hypertensive heart disease accompanied by heart failure and/or chronic kidney disease, acute kidney injury, hypoxia, and acute depressive episodes were the top primary associated readmission etiologies at 30 days and 90 days when correlated with a diagnosis of UC or CD. (Table 1, 2). CONCLUSION Our investigation revealed that patients affected by both depression and either UC or Crohn’s disease exhibited elevated readmission rates and a notably amplified mortality risk at 30 days post-readmission, with a more substantial increase observed at the 90-day mark. These findings underscore the significance of healthcare providers routinely screening for depression, addressing the management of mental health, and acknowledging the considerable impact it has on patients with co-occurring chronic diseases like UC or CD as an integral facet of comprehensive care. Table 1 Table 2

Abstract 041: Readmission Rates and Etiologies among Patients with Intracerebral Hemorrhage: A United States Nationwide Analysis

Introduction Nontraumatic Intracerebral Hemorrhage (ICH) is the second most prevalent type of stroke worldwide and is strongly linked with severe disability and mortality. Survivors of ICH have a high risk of all‐cause readmission. Understanding characteristics of readmitted patients and etiologies of readmission may provide a framework for risk stratification and readmission prevention. Methods We identified patients with a primary diagnosis of ICH (ICD‐10 code: I61.x) from 2016‐2019 using the Nationwide Readmission Database (NRD). The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results A total of 260,854 patients were admitted with a primary diagnosis of ICH between 2016‐2019. The mean age of the cohort was 68.49 years, with 52.6% being male. The 30‐day readmission rate was 7.68% while the 90‐day readmission rate was 12.73%. There was a small but significant increase in 90‐day readmission rates from 2016 to 2019 (12.61% vs 12.93%, p=0.05), but no significant increase in 30‐day readmission rates (7.10% vs 7.72%, p=0.870). Around 60% of 90‐day readmissions occurred within the first 30 days. Patients readmitted within 30 days and within 90 days, compared to those not requiring readmission, were more likely to be younger (68 and 68.1 vs 68.53 years) and male (54.87% and 53.92% vs 52.41) (p<0.001). They also had a higher prevalence of diabetes (32.43% and 32.82% vs 28.42%), dyslipidemia (44.57% and 44.81% vs 41.41%), obesity (13.19% and 13.64% vs 12.03%), prior TIA/ischemic stroke (6.46% and 6.52& vs 5.60%), PVD (6.17% and 6.27% vs 4.88%), coronary artery disease (20.52% and 20.52% vs 17.83%), chronic renal failure (20.52% and 22.21% vs 17.83%), and heart failure (15.98% and 15.87% vs 12.47%) (p<0.001 for all). The most common etiologies of 30‐day readmissions were cardiovascular (38.55%), infectious (12.57%), and neurological (6.96%). In contrast, the most common etiologies of 90‐day readmissions were cardiovascular (36.21%), infectious (12.42%), and respiratory (6.92%). Conclusion There was a small but significant increase in the rate of 90‐day readmissions among patients with ICH between 2016 and 2019. Patients requiring readmission within 30 and 90 days had a significantly higher prevalence of vascular risk factors and related comorbidities. While cardiovascular and infectious conditions were the most common etiologies of readmission among both groups, neurologic conditions contributed more to 30‐day readmissions, while respiratory conditions made up a higher proportion in etiologies of 90‐day readmission. This suggests that further neurologic injury, potentially related to the primary ICH, occurred relatively early on in the course of recovery. Our analysis suggests a possible role of vascular risk factor modification in preventing readmissions after ICH. However, further research is required to validate this hypothesis and to identify other potentially modifiable risk factors.

Abstract 283: Readmission Rates and Etiologies among Patients with Primary Angiitis of the Central Nervous System

Introduction Primary Angiitis of the Central Nervous System (PACNS) is a rare, relapsing inflammatory disorder of blood vessels in the brain and spinal cord presenting clinically with a spectrum of manifestations including strokes, seizures, and neurologic deficits. Limited data are available on the modifiable and nonmodifiable predictors of readmissions for patients diagnosed with PACNS, which hinders the ability of healthcare systems to risk‐stratify patients based on their specific demographics, comorbidities, and hospital status. Methods We identified patients with PACNS (ICD‐10 code: I67.7) admitted from 2016‐2019 using the Nationwide Readmission Database (NRD). The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results We identified 1,398 patients admitted with a primary diagnosis of PACNS between 2016 and 2019. The mean age was 52.81 years, with 59.20% (n=828) being female. The 30‐day readmission rate was 10.52% (n=147) and the 90‐day readmission rate was 19.60% (n=274). Nearly half of 90‐day readmissions occurred within the first 30 days. Annual variations in readmission rates were insignificant. Age and sex distribution were not statistically different between patients not requiring readmission, those readmitted within 30 days, and those readmitted within 90 days. Compared to those not requiring readmission, patients readmitted within 30 days had a higher prevalence of diabetes (38.07% vs 29.06%; p=0.023) and hypertension (65.66% vs 56.88%; p=0.035), while those readmitted within 90 days had a higher prevalence of diabetes (41.56% vs 27.19%, p<0.001), dyslipidemia (48.49% vs 39.77%, p=0.009), obstructive sleep apnea (10.79% vs 6.73%, p=0.028), and ischemic stroke (32.56% vs 25.18%, p=0.013). The most common etiologies of 30‐ and 90‐day readmissions were cardiovascular (47.05% and 47.81%), neurological (26.80% and 20.61%), and infectious (9.07% and 7.58%). Conclusion The rates of 30‐ and 90‐day readmissions among patients with PACNS have remained stable between 2016 and 2019. Patients with PACNS requiring readmission had a higher incidence of vascular risk factors. Cardiovascular, neurological, and infectious conditions were the most common etiologies for 30‐ and 90‐day readmissions. While our analysis suggests a role for vascular risk factor modification to prevent readmissions in patients diagnosed with PACNS, further research is required to validate this hypothesis and identify other modifiable risk factors.

Abstract 077: Readmission Rates and Etiologies among Patients with Subarachnoid Hemorrhage: A Nationwide United States Analysis

Introduction Subarachnoid Hemorrhage (SAH) is the leading cause of morbidity and mortality in stroke patients, associated with severe neurological, infectious, and thromboembolic complications. Identifying clinical predictors linked to hospital readmissions after a SAH allows for the determination of patients with higher risks of complications, opening an avenue for prevention and improved quality of care. Methods The Nationwide Readmission Database (NRD) was used to extract patients with SAH (ICD‐10 code: I60.x) from 2016‐2019. The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results We identified 68,726 patients with SAH, with a mean age of 60.47 years, and 57.86% being female. Overall, 7.79% (n=5354) were readmitted within 30 days and 12.04% (n=8525) were readmitted within 90 days. The rate of 30‐day readmission was overall stable (7.34% in 2016 and 7.70% in 2019; p=0.42), but the 90‐day readmission rate slightly increased from 11.69% in 2016 to 12.47% in 2019 (p=0.04). Around 62% of 90‐day readmissions occurred within the first 30 days. Patients readmitted within 30 days were more likely to be older (mean age = 61.92 vs 60.99 years; p<0.001) and male (43.96% vs 41.74%; p=0.002) compared to those not requiring readmission. They had a higher prevalence of diabetes (23.38% vs 18.82%), hypertension (74.34% vs 70.12%), obesity (13.95% vs 12.25%), dyslipidemia (38.17% vs 33.02%), smoking (39.30% vs 37.43%), prior TIA/ischemic stroke (22.60% vs 20.39%), coronary artery disease (15.03%), DVT (6.06% vs 3.51%), peripheral vascular disease (14.24% vs 11.09%), chronic renal failure (13.34% vs 9.35%), and heart failure (10.57% vs 7.75%) (p<0.001 for all). The most common etiologies of 30‐ and 90‐day readmission were cardiovascular (42.53% and 40.79%), neurological (12.34% and 11.50%), and infectious (8.41% and 8.21%). Conclusion The annual rate of 90‐day readmission, but not 30‐day readmission, increased from 2016 to 2019. Readmitted patients both within 30 and 90 days were more likely to have a higher prevalence of vascular risk factors and related comorbidities.. The most common cause of 30‐ and 90‐day readmission is cardiovascular diseases followed by neurological and infectious conditions. Further studies are required to offer risk stratification and prevention strategies for readmission among patients with Subarachnoid Hemorrhage.

Abstract 262: National Trends of 90‐day Readmission Rates and Etiologies among Diabetics following Transient Ischemic Attack

Introduction Transient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. Type 2 Diabetes Mellitus (T2DM) is a rapidly growing global health problem with increasing prevalence. Currently, data are lacking regarding the trends of 90‐day readmission rates and etiologies among diabetic patients with TIA. Methods We used the Nationwide Readmission Database (NRD) to identify patients with a primary diagnosis of TIA (ICD‐10 code: G45.9) from 2016‐2019 and secondary diagnosis of T2DM. The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results We identified 426,549 patients who were admitted with a primary diagnosis of TIA between 2016 and 2019. Of those patients, 35.43% (n=273,993) were diabetic and 64.57% (n=151,112) were non‐diabetic. Diabetics were more likely to be younger (70.43 vs 70.71 years, p<0.001) and male (46.62% vs 42.89%, p<0.001) compared to non‐diabetics. All‐cause 90‐day readmission was higher among diabetics compared to non‐diabetics (15.22% vs 12.03%, p<0.001). Nearly half of 90‐day readmissions occurred within 30 days. There was no significant difference in the rate of 90‐day readmission between 2016 and 2019 (13.19% in 2016 and 12.95% in 2019). Among diabetics, readmitted patients were more likely to be older (71.87 vs 70.18 years, p<0.001) and male (47.96% vs 46.38%, p<0.001). Readmitted diabetics had a higher prevalence of valvular disease (10.12% vs 7.94%), chronic renal failure (33.40% vs 23.98%), coronary artery disease (40.20% vs 32.86%), heart failure (23.88% vs 16.07%), atrial fibrillation (24.02% vs 18.88%), dementia (13.87% vs 11.13%), cancer (4.18% vs 2.44%), and prior VTE (5.24% vs 4.44%) (p<0.001 for all). The most common etiologies of 90‐day readmission among diabetics were cardiovascular (28.98%), neurological (12.92%), and infectious (7.72%). Conclusion Diabetics had higher 90‐day readmission following TIA than non‐diabetics. Cardiovascular conditions were the most common cause of readmission followed by neurological and infectious causes. Further studies are needed to improve risk stratification for diabetic patients following TIA and prevent all‐cause readmission.

Epidemiology and Predictors of 30-Day Readmission in CAR-T Cell Therapy Recipients

The novel cellular immunotherapy using chimeric antigen receptor (CAR) T cells has transformed the management of several previously incurable hematologic malignancies. Since the first CAR-T cell product was approved by the Food and Drug Administration in 2017, five additional products have been approved for various hematologic malignancies. Although there is now more experience with outpatient administration, CAR-T therapy was initially delivered in an inpatient setting. The unique complications of cytokine release syndrome (CRS) and neurologic side effects (commonly known as immune effector cell-associated neurotoxicity syndrome [ICANS]), along with a higher risk for infection, increase the risk for hospital readmission. Given the recent approval of CAR-T therapy, large-scale epidemiologic data are lacking. The present study aimed to characterize the epidemiology of hospitalizations, readmissions, and factors associated with all-cause 30-day readmission post CAR-T therapy. This retrospective cohort study used the Nationwide Readmissions Database from 2017 to 2019 to identify hospitalizations for CAR-T therapy administration. A descriptive analysis was performed after categorizing these hospitalizations as non-Hodgkin lymphoma, multiple myeloma, or leukemia. The readmission rate was calculated, and etiologies of readmission were identified. A Cox proportional hazards model was used to elucidate factors associated with 30-day readmission. We also estimated the healthcare utilization related to readmissions, including total hospital charges and length of stay. The 2,964 CAR-T therapy-related admissions included 2,176 with a diagnosis of non-Hodgkin lymphoma, 344 with multiple myeloma, and 445 with leukemia. The median length of stay was 15 days. Most CAR-T therapy recipients were male (63.4%), admitted to a teaching hospital (99.2%); 49.3% had private insurance, and 33.2% belonged to the highest-income communities. CAR-T therapy was administered mostly in privately owned (89.5%) large-sized hospitals (74.4%) in large metropolitan regions (91.4%). Median total hospital charges were highest for non-Hodgkin lymphoma, followed by leukemia and multiple myeloma ($945,645 versus $265,034 versus $184,194; P < .001). All-cause mortality during index hospitalization was highest for leukemia at 8.6%, followed by 3.6% for non-Hodgkin lymphoma and 1.4% for multiple myeloma (P < .001). The 30-day all-cause readmission rate was 23.6%, and the median time to readmission was 7 days. The readmission rate was highest for leukemia, followed by non-Hodgkin lymphoma and multiple myeloma (34.2% versus 22.8% versus 15.7%; P < .001). Readmission incurred an additional median total hospital charge of $64,561. During readmission, median length of stay was 5 days, and in-hospital mortality was 4.9%. Top etiologies for readmission were cancer or treatment-related (22%), sepsis or infection (18%), neurologic events (15%), neutropenia or pancytopenia (11%), and fever, hypotension, or hypoxia (8%). On multivariable analysis, non-Hodgkin lymphoma and leukemia (compared with multiple myeloma), transfer to a facility at discharge, chronic renal disease, cerebrovascular disease, and noninvasive ventilation were associated with higher odds of readmission. In contrast, admission to a teaching hospital predicted lower odds of readmission. Almost a quarter of CAR-T therapy recipients are readmitted within the first 30 days resulting in additional economic burden and substantial healthcare utilization.

Procedure-Related Outcomes Including Readmission Following Spinal Cord Stimulator Implant Procedures: A Retrospective Cohort Study.

Spinal cord stimulation (SCS) has been shown to reduce opioid consumption, reduce pain, improve quality of life compared to conventional therapy, and be more effective than spine reoperation in carefully selected patients. In this study, we evaluate readmissions after SCS implantation procedures, costs, predictors, and etiologies for readmission following implantation procedures. The study was a retrospective cohort using the National Readmissions Database from 2013 to 2017. Administrative billing codes were used to identify patients undergoing SCS implantation procedures. The primary outcome of our study was 30-day readmission following the SCS implantation procedure. Continuous outcomes were compared between groups using the Student t test or Wilcoxon rank sum test. In addition, multivariable predictors of 30-day readmission were assessed by hierarchical logistic regression analysis. A total of 3737 (26.7% open surgical SCS implants [OS-SCS]) individuals admitted to the hospital for SCS implantation were included in the final cohort analysis. The cohort consisted of predominantly female patients (58.71%) and in the 50- to 64-year age group (35.46%). Patients who underwent open surgical SCS implantation had a longer length of stay during the initial admission and a higher 30-day readmission rate (9.4% vs 7% P = .01). OS-SCS, older age, lower socioeconomic status, patients with specific comorbidities (ie, hypertension or chronic obstructive pulmonary disease [COPD]), and home discharge are associated with readmission. Readmission rates after SCS implantation are around 7.7% in the United States. Infection and postoperative complications remain the top etiologies for readmission. Open surgical SCS implantation is associated with more extended initial hospitalization and a higher rate of readmission when compared to percutaneous SCS implantation procedures.

Type 2 Myocardial Infarction in Young Adults: Insights From the National Readmission Database.

IntroductionType 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. T2MI is often diagnosed in patients with a higher risk of morbidity and mortality. T2MI in young adults is poorly understood due to limited available data.MethodsThe Nationwide Readmission Database 2017-2018 was queried for admission with T2MI diagnosis in young adults (age ≤ 45 years). Index admissions with T2MI were identified. Other types of myocardial infarction and observations with missing data were excluded. December admissions were excluded to allow the 30-day follow-up. Cox proportional hazard multivariate regression model was used to determine predictors of readmissions. All P-values were two-sided, with 0.05 as the threshold for statistical significance.ResultsA total of 11,750 patients with a secondary diagnosis of T2MI were admitted between October 2017 and November 2018. The main primary etiologies of index admission were sepsis (14%) followed by hypertensive heart disease with heart failure (11%) and hypertensive emergency (7%), while main etiologies of readmission were hypertensive heart disease with heart failure (12%) followed by sepsis (9%) and acute kidney injury (3%). Valvular heart disease, chronic pulmonary disease, drug abuse, and depression were amongst the predictors of all-cause readmission.ConclusionWe identified primary etiologies of admission and readmission, and predictors of readmissions in young adults presenting with T2MI. Further studies are needed to guide the management of T2MI in this age group.

Causes, risk factors, and costs associated with ninety-day readmissions following primary total hip arthroplasty for femoral neck fractures

IntroductionRisk factors associated with primary THA readmissions have not yet been thoroughly analyzed when stratified by underlying indication. Given that a majority of THAs are done electively in the context of osteoarthritis (OA), it remains to be explored whether or not THAs performed non-electively in the trauma setting have different readmission patterns. Therefore, the aims of this study were to identify: 1) causes of readmissions; 2) patient-related risk-factors for readmissions; and 3) costs associated with the reasons for readmissions. Materials and methodsPatients who sustained a femoral neck fracture and underwent primary THA from 2005 to 2014 were identified. Those subsequently readmitted within 90-days following the procedure comprised the study cohort whereas those not readmitted served as the comparison cohort. Primary outcomes included identifying causes of readmissions, identifying patient-related risk-factors associated with readmissions and determining healthcare expenditures associated with the different readmission etiologies. A regression analysis was used to calculate the odds (OR) for readmissions. A p-value less than 0.01 was considered to be statistically significant. ResultsThe regression model demonstrated the greatest patient-related risk factors included: electrolyte and fluid disorders (OR: 1.80, p < 0.0001), morbid obesity (OR: 1.60, p < 0.0001), pathologic weight loss (OR: 1.58, p < 0.0001), congestive heart failure (OR: 1.41, p < 0.0001), were the leading risk factors for readmissions. Pulmonary-related causes ($42,357.71) of readmission were the leading driver of costs of care. ConclusionOrthopaedic surgeons should identify and optimize pre-operative management of patient-related risk factors that increase readmissions following primary THA for femoral neck fractures. Additionally, pulmonary-related causes of readmission lead to the highest costs of care. Level of EvidenceIII.

Female sex as an independent predictor of high bleeding risk among East Asian percutaneous coronary intervention patients: A sex difference analysis

BackgroundSex differences in the outcomes following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have been identified in Western countries. However, data on the long-term outcomes for bleeding events, particularly in East Asia where the aging population is growing rapidly and consists predominantly of women, remain scarce. MethodsWe analyzed 2,494 ACS survivors from a multicenter PCI registry who underwent PCI between 2009 and 2012. The primary outcome was readmission for major bleeding at 2 years. Survival curves were generated with the cumulative incidence function. The adjusted hazard ratios were evaluated for the primary outcomes by sex using (1) Fine-Gray models and (2) Cox regression models. ResultsThere were 548 women (22.0%) in this cohort. The women were older (73.7 ± 10.8 years vs. 65.4 ± 11.8 years, p < 0.001), had a lower body mass index (23.0 ± 3.9 vs. 24.3 ± 3.6, p < 0.001), and had more comorbidities such as renal failure (49.4% vs. 36.3%, p < 0.001) and previous heart failure (8.4% vs. 4.5%, p < 0.001). Fewer women were discharged with statins (81.9% vs. 86.5%, p = 0.025) or beta blockers (70.6% vs. 77.1%, p = 0.007). During the 2-year follow-up, the unadjusted readmission rates for bleeding were higher among women (4.9% versus 2.4% at 2 years after discharge). Multivariable competing risk analysis with the Fine-Gray model and Cox regression model further demonstrated that female sex was associated with a higher risk of bleeding. ConclusionsAmong patients treated with PCI, women had a higher incidence of bleeding events requiring readmission. Sex disparities in the etiologies of readmission following PCI suggest the need for targeted treatment strategies. A strict follow-up after discharge could be beneficial for women to further reduce their risk.

Abstract 14165: In-hospital Outcomes and 30-day Readmissions in Patients Hospitalized With Myocarditis

Introduction: Myocarditis, induced by various etiologies, remains a major cause of dilated cardiomyopathy. Data on patient characteristics, hospital outcomes and readmissions of myocarditis remains limited. Our study evaluated outcomes and 30-day readmission rates of patients admitted with myocarditis. Methods: We retrospectively analyzed the US National Readmissions Database years 2016-2017 for all adults (age ≧ 18 years) with an index admission for myocarditis. The primary outcomes sought were inpatient mortality, ventricular fibrillation (VF)/ sudden cardiac death (SCA) and 30 day readmission rates. Secondary outcomes included: patient characteristics and diagnostic or therapeutic interventions. Results: A total of 7100 index admissions with myocarditis were identified whereby males composed the majority of admissions (64.9%). Women were at a significantly greater risk of VF/SCA (5.2% vs 2.1%, p&lt;0.05) and cardiogenic shock (10.2% vs 4.7%, p&lt;0.001). In-hospital mortality was greatest in females (3.8% vs 1.4%, p&lt;0.001). Temporary mechanical circulatory support was utilized more among females as compared to males by way of IABP (2.4% vs 0.9%, p = 0.002) or PVAD (1.9% vs 0.9%, p = 0.009). Mean length of stay was greater in females (3 ± 5 vs 2 ± 3 days, p&lt;0.001). The overall 30-day readmission rate was 6.4% and the top three etiologies for readmission in order of frequency were: myocarditis, acute on chronic systolic heart failure and sepsis. Conclusions: Significant gender outcome disparities were noted among identified index admissions for myocarditis. Females had disproportionately higher rates of VF/SCA, cardiogenic shock and inpatient mortality. Additionally, females had a higher rate of temporary mechanical circulatory support utilization and a longer length of stay. The overall 30 day readmission rate was significant at 6.4% with the most frequency causes of readmission being recurrent myocarditis, acute on chronic systolic heart failure and sepsis.

Assessing readmission after axicabtagene ciloleucel immunotherapy.

3024 Background: Axicabtagene ciloleucel (axi-cel) is an FDA approved CD19 targeted CAR-T for patients (pts) with diffuse-large-B cell lymphoma (DLBCL) after 2 lines of treatment. Pts are monitored inpatient for minimum 7 days after CAR-T infusion but remain at risk of complications after discharge that can lead to readmission. We report our institutional experience on the rate and etiology of readmissions after initial discharge. Methods: In this retrospective study, readmission was defined as an inpatient stay greater than 48 hours while under the auspice of the Immunotherapy service. Cytokine release syndrome (CRS) and neurotoxicity (NT) were graded based on the Lee and CTC v.4 criteria, respectively. Logistic regression models were used to study the association between clinical factors and readmission. Results: 44 pts received axi-cel. Median age was 62 (25-79). 33 pts (75%) had primary refractory disease and 14 (30%) had prior transplant. Pts had median 3 lines (2 -9) of treatment before axi-cel. Median time from most recent treatment to leukapheresis was 10 weeks (0.5-109). 22 pts (48%) received bridging therapy between leukapheresis and lymphodepletion (LD). Median duration of initial planned admission was 7.5 days (6-16). Incidence of CRS was 88% (all grades) and 12% (grade 3/4). Median time to start of CRS was 3 days (0-13). Incidence of NT was 61% (all grades) and 16% (grade 3/4) and median time to NT was 6 days (3-14). 6 pts (14%) were readmitted after initial hospitalization (1 had 2 readmissions). Median day of readmission was 13 (9-25). Median duration of subsequent hospitalization was 5 days (2-31). Reasons for readmission were: infection (2), CRS (2), GI bleed (1), progressive disease (PD) (1) and NT (1). 4 of 6 pts had no CRS or NT before readmission. 2 of the 4 were readmitted on days 9 and 13 for NT. The other 2 pts were readmitted for infection and GI bleed. 1 pt had grade 2 CRS and grade 2 NT during first admission and was readmitted on day 25 for PD. Last pt had grade 2 CRS and grade 3 NT during first admission with discharge day 13, readmission day 14 through day 17 with recurrent NT and second readmission day 30 for infection. 3 of 6 pts had ICU admissions during second admissions. There was no association between pre- and post- CAR-T variables and risk of readmission in multivariable models. Conclusions: Readmissions after discharge from initial planned hospitalization for axi-cel are not uncommon. This data supports our current policy of close monitoring until at least a month after CAR-T therapy and supports the requirement of a full-time caregiver until discharge from the Immunotherapy service.

Impact of Frailty on Mortality, Readmissions, and Resource Utilization After TAVI

With aging population and preponderance of severe aortic stenosis occurring in elderly patients, the number of transcatheter aortic valve implantations (TAVI) performed in the elderly are growing. Frailty is common in the elderly and is known to be associated with worse outcomes. We aimed to evaluate the impact of frailty on hospital readmissions rates after TAVI. We used the 2016 Nationwide Readmission Database and categorized patients who underwent TAVI low, intermediate, and high frailty status. The primary outcome was 6-months readmission rates across the 3 frailty categories. Secondary outcomes included causes of readmissions, in-hospital mortality and cost of care. STATA 16.0 was used for survey-specific statistical tests. Of 20,504 patients who underwent TAVI, 58.9% were low-, 39.6% were intermediate-, and 1.5% were in the high-frailty group. Overall in-hospital mortality was 1.9% (n = 396), and was 0.6%, 3.3%, and 16.8% (p <0.01) with increasing frailty. Of the 20,108 patients who survived to discharge, 6,427 (32%) patients were readmitted within 6-months after TAVI. Readmission rates increased across the categories from 27.9% in low, 37.6% in intermediate and 51.1% in high frailty group (p <0.01). While cardiac causes (mostly heart failure) were the predominant readmission etiologies across frailty categories (low: 51.2%, intermediate: 34.1%, high: 27.2%), rates of infectious and injury-related readmissions increased (low: 11%, intermediate: 30%, high: 45%). Mortality during readmissions also worsened from 0.8%, 5.3%, and 8.5% (p <0.01). Over 40% of patients undergoing TAVI were of intermediate-high frailty. In conclusion, an increasing frailty was associated with significantly worse postprocedure mortality, readmissions, and related mortality.

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival.

Acute mesenteric ischemia (AMI) remains a vascular emergency. Our aim was to explore readmission for AMI. We identified all patients admitted for AMI from the state of California through the Healthcare and Utilization Project from 2005 to 2011. Our primary end point was the rate and etiology for readmission. Our secondary end points were the length of hospitalization and in-hospital mortality. Cox proportional hazard regression was utilized to assess risk of 30-day readmission. There were 534 (9.9%) readmissions at 30 days. The mean age was 67 ± 17 years and 209 (39.1%) were male. The five most common etiologies for readmission were AMI (7.6%), cardiac events (5.3%), severe sepsis (1.2%), dehydration (1.1%), and acute kidney failure (1.1%). Once readmitted, these patients were most likely to experience cardiac catheterizations (25.4%), red blood cell transfusions (23.6%), intubation and mechanical ventilation (17.6%), biopsy of the large intestine (13.9%), reoperation for small bowel resection (10.9%), administration of total parenteral nutrition (10.5%), and transfusion of other blood products (6.9%). This hospitalization was 8.8 ± 12.7 days long. In-hospital mortality was 36 patients (6.7%). On multivariable Cox-regression analysis, severe (hazard ratio [HR]: 2.1 [1.4-3.2], p = 0.0005) and moderate (HR: 1.5 [1.03-2.13], p = 0.04) Elixhauser Comorbidity Group, complications (HR: 1.5 [1.2-1.9], p = 0.0007), and longer index hospitalization (HR: 1.02 [1.01-1.02], p < 0.0001) were predictors of readmission. Conclusion AMI remains a vascular emergency. Readmissions have a significant rate of morbid invasive procedures and can lead to an in-hospital mortality of 6.7%. The adoption of guidelines similar to the European Society for Trauma and Emergency Surgery should be considered.

Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study.

Infective endocarditis (IE) is a life threatening disease requiring lengthy hospitalizations, complex multidisciplinary management and high health care costs. In this study, we analyzed the National Readmissions' Database (NRD) to identify infective endocarditis cases and the causative organisms, clinical determinants, length of stay, in-hospital mortality, and 30-day hospital readmission rates. The study cohort was derived from Healthcare Cost and Utilization Project's National Readmission Database between 2010-15. We queried the National Readmissions' Database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for infective endocarditis (421.0) and identified a total of 187,438 index admissions. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for statistical analyses. A total of 187,438 patients with a primary diagnosis of IE were identified over 6 years (2010-2015). Twenty-four percent (44,151 patients) were readmitted within 30 days. Most common etiologies for readmission included sepsis (14%), acute heart failure (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Predictors of increased readmissions included female sex, staphylococcus aureus infection, diabetes, chronic lung disease, chronic liver disease, acute kidney injury, acute heart failure and anemia. In-hospital mortality for the readmission of IE was 13%, and average length of stay during the re-admission was 12 days. IE is associated with high rates of index admission mortality and for 30-day readmissions of which are associated with a substantial risk of death.

Morbidity Following Hand-Assisted Laparoscopic Donor Nephrectomy.

Background: The incidence of morbidity and readmission rate after hand-assisted laparoscopic donor nephrectomy (HALDN) is not clear. Aims: Our study aims to review our experience with HALDN, mainly the reasons for patient readmissions. Methods: Prospectively collected data on all patients undergoing HALDNs between August 2007 and June 2015 were retrieved. The primary outcome was 30-day readmission rate. Secondary outcomes were complications and readmission etiology. Results: There were 161 nephrectomies with a median age of 51 years, 72 (44.7%) men, and 114 (70.8%) left-sided operations. Twenty-one (13%) individuals were readmitted within 30 days. There were total 25 (15.5%) readmissions during the study period. The characteristics of patients readmitted and patients not readmitted were broadly similar. Nine of 21 (43%) individuals readmitted had nonspecific findings (nonspecific findings on imaging, negative blood cultures, and raised inflammatory markers). The reasons for readmission were unrelated to nephrectomy in 24% and 19% required surgery for complications unrelated to nephrectomy. Conclusion: We observed a high readmission rate after HALDN. A significant proportion of readmissions were due to nonspecific abdominal pain associated with raised inflammatory markers and no obvious source of sepsis. Living donors should be fully informed about the risks including the possibility of complications unrelated to HALDN.

P1577Incidence, etiologies and predictors of 30-day readmission after percutaneous coronary intervention in end-stage renal disease patients; Analysis from national readmission database

Abstract Background End stage renal disease (ESRD) is a known risk factor for coronary artery disease (CAD). The association of ESRD with short-term readmissions after percutaneous coronary intervention (PCI) has not been well studied. Purpose This study aims to examine he 30-day readmission rate, predictors of readmission and etiologies of readmission in ESRD patients after PCI. Methods and results The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in ESRD patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. Results We evaluated 96,869 hospitalized patients who survived to discharge after PCI from January through November 2014 and analyzed unplanned readmissions over 30 days after discharge. A total of 11,624 patients (12%) were readmitted within 30 days. Among the readmitted patients, majority of readmissions were due to non-cardiac causes. Nineteen percent had congestive heart failure (HF), 11% had PCI, 2% had coronary artery bypass surgery, and 1.5% died during the readmission. Acute respiratory failure (21%) and infections (14%) compromised majority of non-cardiac causes. Predictors of increased readmissions were female sex (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01- 1.0, p&lt;0.001), infections (OR 2.06, 95% CI 1.44–2.4, p&lt;0.001), diabetes (OR 1.91, 95% CI 1.07–2.63, P&lt;0.001), chronic lung disease (OR 3.16, 95% CI 2.11–4.2, p&lt;0.001), chronic liver disease (OR 1.96, 95% CI 1.1–2.23, p&lt;0.001), acute HF (OR 1.17, 95% CI 1.12–1.22, p&lt;0.001) and anemia (OR 1.09, 95% CI 1.06–1.13, p&lt;0.001). Conclusion ESRD patients are at high risk of 30-day readmissions after PCI. Although majority of patients are readmitted with non-cardiac causes, HF and repeat PCI were the most common cardiac etiologies of readmissions. Female sex, infections, chronic liver and lung diseases are independently associated with high risk of 30-day readmission in ESRD patients after PCI. Acknowledgement/Funding None

Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair.

Hospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies. The medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians. A total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group. Patients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.

Readmissions in ST-Elevation Myocardial Infarction and Cardiogenic Shock (from Nationwide Readmission Database)

Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is paucity of data on readmissions in this study population. We aimed to assess the burden, major etiologies, and resource utilization for 30-day readmissions among patients with STEMI and CS. The Nationwide Readmission Database was queried from 2010 to 2014. All adult patients with an index admission for STEMI-CS were identified using International Classification of Diseases, ninth edition codes. Patient with mortality on index admission and transfers to other hospitals were excluded. A total of 18,659 admissions were identified with primary diagnosis of STEMI-CS for the study duration. Percutaneous coronary interventions was performed in 78.1% and mechanical circulatory devices were utilized in 53.9% with a mean length of stay of 10.6 (±0.2) days and mean cost of hospitalization of $47,744 (±327). Among these, 2,404 (12.9%) patients were readmitted within 30 days. Major etiologies for readmission include congestive heart failure (25.7%), acute myocardial infarction (9.4%), arrhythmias (4.5%), and sepsis (4.2%). The mean length of stay and cost of hospitalization for 30-day readmission were 5.9 (±0.3) days and $17,043 (±590), respectively. Older age, female gender, lower socioeconomic status, and discharge to home health care were significant predictors for readmission. In conclusion, there is a significant burden of 30-day readmission among patients with STEMI-CS. Percutaneous coronary interventions and mechanical circulatory devices were utilized in a majority of index admissions. Congestive heart failure was the single most common reason for 30-day readmission. Patients discharged to skilled nursing facility, patients with private insurance and higher socioeconomic status were less likely to be readmitted. Moreover, readmissions among STEMI-CS patients contribute to significant resource utilization.