Higher Odds Of Readmission Research Articles

Risk factors for unexpected admission following arthroscopic and open treatment of shoulder instability: a national database study of 11,230 cases.

Shoulder instability procedures have low morbidity; however, complications can arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission and reoperation following arthroscopic and open treatment for shoulder instability. The American College of Surgeons National Surgical Quality Improvement Program database was queried to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests, chi-square, and (where appropriate) Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission and reoperation following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Of the 11,230 cases included in our sample, only 0.54% were readmitted, and 0.23% underwent reoperation within the 30-day postoperative period. Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission and reoperation: open repair, congestive heart failure (CHF), and hospital length of stay. Unplanned 30-day readmission and reoperation after shoulder instability surgery is infrequent. Patients with American Society of Anesthesiologists class II, CHF, longer than average hospital length of stay, or an open procedure have higher odds of readmission than patients without those factors. Patients who have CHF, longer than average hospital length of stay, and open surgery have higher odds of reoperation than others. Arthroscopic procedures should be used to manage shoulder instability, if possible.

Readmissions and postdischarge mortality by race and ethnicity among Medicare beneficiaries with multimorbidity.

Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics. We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity. The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR=1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity. Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.

Frailty Is Independently Associated with Higher Mortality and Readmissions in Patients with Acute Biliary Pancreatitis: A Nationwide Inpatient Study.

Acute pancreatitis is the most common gastrointestinal cause of hospital admissions in the United States of which biliary or gallstone disease is the most common inciting factor. Estimate the effects of frailty on burden, costs, and causes for hospitalization in patients with acute biliary pancreatitis. We analysed the Nationwide Readmission Database from 2016 to 2019 for patients with acute biliary pancreatitis. Patients were categorized into two groups, frail and non-frail, based on the Hospital Frailty Risk Score. Logistic and Cox regression were used to predict the impact of frailty on 30-day readmission, length of stay, mortality, and costs. 162,202 index hospitalizations with acute biliary pancreatitis without cholangitis were identified, of whom 59.2% (n = 96,045) were female and 22.49% (n = 36,475) were classified as frail. Readmissions within 30days were higher among frail patients (12.58% vs 7.09%, P < 0.001) compared to non-frail patients, respectively. Regression modeling showed that frail patients had higher odds of readmission (OR 1.32; 95% CI 1.24-1.42, P < 0.001), longer lengths of stay (8.18days vs 4.11days), and higher average costs of hospitalization ($21,511 vs $12,261) compared to non-frail patients, respectively. Cox regression showed that frail patients had a higher risk of mortality (HR 5.43; 95% Cl 4.06-7.29, P < 0.001) compared to non-frail patients, respectively. Frailty is independently associated with higher mortality and burden of healthcare utilization in patients with acute biliary pancreatitis. We suggest using the Hospital Frailty Risk Score as part of the treatment algorithm in patients with acute biliary pancreatitis.

Postoperative adverse events following gender-affirming vaginoplasty: an American College of Surgeons National Surgical Quality Improvement Program study

As a part of gender-affirming care, many transgender women undergo vaginoplasty surgery, which is increasingly being performed in the United States. There are considerable knowledge gaps about adverse events associated with vaginoplasty as most published articles report single-center results. This study aimed to describe severe and overall 30-day adverse events after gender-affirming vaginoplasty using a large multicenter database. This was a retrospective cohort study of transgender women who underwent vaginoplasty between 2011 and 2019 using the American College of Surgeons National Surgical Quality Improvement Program database. Cases were initially identified by diagnosis codes for gender identity disorders and procedure codes for male-to-female vaginoplasty. Adverse events at 30 days were identified, including unplanned reoperation or readmission, blood transfusion, wound dehiscence, surgical site infections, thromboembolic disease, sepsis, cerebrovascular or cardiac events, and urinary tract infection. Surgical procedures were further stratified by Clavien-Dindo grade, a standardized classification system for registering surgical complications. A score of 0 is given if there is no adverse event, whereas scores of 1 and 2 refer to deviations from the normal postoperative course, which may include additional pharmacologic treatment, bedside-managed wound complications, and blood transfusions. Clavien-Dindo grades of 3 to 4 include surgical interventions or life-threatening complications requiring intensive care unit management. A Clavien-Dindo grade of 5 is given for any complication resulting in death. A total of 488 cases were eligible for inclusion in this study. The mean age of the cohort was 37.5 years, and race distribution was as follows: 71.1% White, 15.2% Black, 5.5% Asian or Pacific Islander, and 8.2% other. Of the cohort, 18.6% were Hispanic. Surgeries were performed by plastic surgeons (87.9%), urologists (8.6%), gynecologists (1.8%), and other specialists (1.6%). Concurrent nongenital surgery was performed in 17% of cases. The median operative time for all cases was 271 minutes (interquartile range, 214-344). There was no reported death in the 30-day period (Clavien-Dindo grade 5), and 27 cases (5.5%) had a Clavien-Dindo grade of 3 to 4. On multivariate analysis, body mass index and higher American Society of Anesthesiologists class were associated with higher odds of having a Clavien-Dindo grade of 3 to 4 (adjusted odds ratios, 2.9 [95% confidence interval, 1.32-4.21; P=.01] and 1.23 [95% confidence interval, 0.56-2.57; P=.05], respectively). Wound dehiscence, superficial surgical site infection, or deep surgical site infection occurred in 46 cases (9.0%). The readmission rate was 4.3% (n=21). Several preoperative factors had higher odds of readmission: body mass index (adjusted odds ratio, 9.81; 95% confidence interval, 1.77-22.13; P=.005), higher American Society of Anesthesiologists class (adjusted odds ratio, 3.23; 95% confidence interval, 1.23-9.03; P=.003), diabetes mellitus (adjusted odds ratio, 5.39; 95% confidence interval, 1.42-20.45; P=.006), and hypertension (adjusted odds ratio, 3.63; 95% confidence interval, 1.26-10.47; P=.01). The reoperation rate was 4.7% (n=23), with no significant patient factor associated with this complication. Of the reoperations, 68.2% of cases were due to wound problems, vaginal bleeding, or hematoma. In transgender women undergoing vaginoplasty for gender affirmation, severe postoperative complications were rare, occurring in 1 of 20 patients. Most patients experienced minor complications or no complication after surgery.

Identifying Risk Factors for Complication and Readmission with Same-Day Discharge Arthroplasty

BackgroundThe COVID-19 pandemic caused a surge of same-day discharge (SDD) for total joint arthroplasty. However, SDD may not be beneficial for all patients. Therefore, continued investigation into the safety of SDD is necessary as well as risk stratification for improved patient outcomes. MethodsThis retrospective cohort study examined 31,851 elective SDD hip and knee arthroplasties from 2016 to 2020 in a large national database. Logistic regression models were used to identify patient variables and preoperative comorbidities that contribute to postoperative complication or readmission with SDD. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. ResultsSDD increased from 1.4% in 2016 to 14.6% in 2020. SDD is associated with lower odds of readmission (AOR: 0.994, CI: 0.992-0.996) and postoperative complications (AOR: 0.998, CI: 0.997-1.000). Patients who have preoperative dyspnea (AOR: 1.03, CI: 1.02-1.04, P < .001), chronic obstructive pulmonary disease (AOR: 1.02, CI: 1.01-1.03, P = .002), and hypoalbuminemia (AOR: 1.02, CI: 1.00-1.03, P < .001), had higher odds of postoperative complications. Patients who had preoperative dyspnea (AOR: 1.02, CI: 1.01-1.03), hypertension (AOR: 1.01, CI: 1.01-1.03, P = .003), chronic corticosteroid use (AOR: 1.02, CI: 1.01-1.03, P < .001), bleeding disorder (AOR: 1.02; CI: 1.01-1.03, P < .001), and hypoalbuminemia (AOR: 1.01, CI: 1.00-1.02, P = .038), had higher odds of readmission. ConclusionSDD is safe with certain comorbidities. Preoperative screening for cardiopulmonary comorbidities (eg, dyspnea, hypertension, and chronic obstructive pulmonary disease), chronic corticosteroid use, bleeding disorder, and hypoalbuminemia may improve SDD outcomes.

Editor's Spotlight/Take 5: Postacute Care Readmission and Resource Utilization in Patients From Socioeconomically Distressed Communities After Total Joint Arthroplasty.

Editor's Spotlight/Take 5: Postacute Care Readmission and Resource Utilization in Patients From Socioeconomically Distressed Communities After Total Joint Arthroplasty.

7: ASSESSMENT OF READMISSION RISK FACTORS AFTER INDEX HOSPITAL DISCHARGE FOR COVID-19 PATIENTS

Introduction: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. Methods: This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. Results: Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18–40 years (OR 2.76; 95% CI, 2.23–3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23; 95% CI, 1.10–1.39), no ICU admission at index hospitalization (OR 1.70; 95% CI, 1.32–1.80), and Hospital length of stay ≤14 vs >14 days (OR 1.53; 95% CI, 1.32–1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14; 95% CI 1.84–2.48), hypertension (OR 1.58; 95% CI 1.40–1.78), congestive Heart Failure (OR 2.54; 95% CI 2.16–2.98), chronic pulmonary disease (OR 2.26; 95% CI 1.94–2.63), diabetes (OR 1.32; 95% CI 1.17–1.49) or chronic kidney disease (CKD) (OR 2.41; 95% CI 1.2.09–2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay ≤14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay ≤14 days and age >60 years remained independent risk factors for readmission within 30 days. Conclusions: Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.

S107 A Readmission Predictor Model to Identify High-Risk Patients With Crohn’s Disease

Background: Crohn’s disease is a chronic inflammatory autoimmune disease with unknown etiology that most commonly affects the younger population and females. Hospital readmission is frequent, burdensome, and costly. We investigated 30-day readmission rates, causes, risk factors, and interventions to reduce hospital readmission in patients who received medical treatment for Crohn’s disease. Methods: The Nationwide Readmission Database (HCUP) was queried from 2019-2022. Data on hospital readmissions of 1,048,576 adults who were readmitted within 30 days was collected. Our study first applied standard logistic regression and decision trees to obtain influential variables and derive practically meaningful decision rules. We then stratified the original data set and applied logistic regression to each data stratum. Finally, using area under the curve and odds ratio, we further explored the risk and accuracy of interacting variables in the logistic regression modeling. Results: A total of 1,048,576 patients were readmitted between 2019-2022. Of these, 15,438 (Mean age 56.4 ± 12.4, 57% women) patients were included after the propensity score matching. 7519 (48%) patients were Crohn’s positive. Multiple logistic regression of the independent variable showed a readmission probability of 8.3% in bottom quartile income (P < 0.01), 10.9% in HLD on medication (P < 0.01), 7.6% in COPD (P < 0.01), 6.8% in sepsis (P < 0.01), 4.8% in heart failure (P < 0.01), and 5.2% in insured patients (P < 0.01). The odds of readmission were increased in patients with a history of hypertension requiring medication (OR 1.201, P < 0.01), HLD requiring medication (OR 1.758, P < 0.01), COPD (OR 1.25, P < 0.01), sepsis (OR 1.10, P < 0.01), bottom quartile of income (OR 1.29, P < 0.01), and insured status (OR 1.03, P < 0.01). In addition, the female sex was associated with higher odds of readmission (OR 1.01, P < 0.01). Accuracy of bottom quartile income was also significant for AU ROC (0.664, P < 0.01) and insured status AU ROC (0.564, P < 0.01) as compared to the logistic regression. Conclusion(s): Our results suggest that patients with certain comorbid medical conditions, insurance status, and in bottom quartile income are at increased risk for readmission. Research is needed to determine if targeted interventions for high-risk patients bdecrease readmissions.

S108 Predictor Model to Identify High-Risk Groups for Readmission in Patients With Ulcerative Colitis

Background: Ulcerative colitis is characterized by recurring episodes of inflammation limited to the colon's mucosal layer. It commonly involves the rectum and may extend proximally and continuously to affect other parts of the colon. Risk factors for readmission over the first few weeks may differ from those that influence re-hospitalization at later time points. We investigated 30-day readmission rates, causes, risk factors, and interventions to reduce hospital readmission in patients who received medical treatment for ulcerative colitis. Methods: The Nationwide Readmission Database (HCUP) was queried from 2019-2022. Data on hospital readmissions of 1,048,576 adults who were readmitted within 30 days was collected. Our study first applied standard logistic regression and decision trees to obtain influential variables and derive practically meaningful decision rules. We then stratified the original data set and applied logistic regression to each data stratum. Finally, using the area under the curve and odds ratio, we further explored the risk and accuracy of interacting variables in the logistic regression modeling. Results: A total of 1,048,576 patients were readmitted between 2019-2022. Of these, 13,358 (Mean age 52.4 ± 10.4, 52% women) patients were included after the propensity score matching. 6215 (46%) patients were ulcerative colitis positive. Multiple logistic regression of the independent variable showed a readmission probability of 6.4% in the bottom quartile income group (P < 0.01), 5.3% in HLD on medication (P < 0.01), 1.3% in sepsis (P < 0.01), 4.7% in heart failure (P < 0.01), and 8.4% in insured patients (P < 0.01). The odds of readmission were increased in patients with a history of HLD requiring medication (OR 1.203, P < 0.01), heart failure (OR 1.303, P < 0.01), sepsis (OR 2.021, P < 0.01), bottom quartile of income (OR 1.45, P < 0.01), and insured status (OR 1.33, P < 0.01). In addition, the female sex was associated with higher odds of readmission (OR 1.21, P < 0.01). Accuracy of median income was also significant for AU ROC (0.632, P < 0.01) and insured status AU ROC (0.511, P < 0.01) as compared to the logistic regression. Conclusion(s): Our results suggest that patients with comorbid medical conditions, insured status, and bottom quartile of income at increased risk for readmission. Research is needed to determine if targeted interventions for high-risk patients decrease readmissions.

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.

Postdischarge Racial and Ethnic Disparities in Pediatric Appendicitis: A Mediation Analysis

IntroductionSignificant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge. Materials and MethodsWe performed a retrospective cohort study of children (aged < 18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status– mediated disparate outcomes. ResultsA total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively. ConclusionsChildren of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.

The 30-day hospital readmission and mortality after surgery in colorectal cancer patients

PurposeHospital readmissions in the first weeks following surgery are common, expensive, and associated with increased mortality among colorectal cancer patients. This study is designed to assess the 30-day hospital readmission after colorectal cancer surgery and evaluate the risk factors that affect hospital readmission.MethodsThe study uses data from the Ministry of National Guard-Health Affairs Cancer Registry. All colorectal cancer patients who underwent colorectal cancer surgery between January 1, 2016, and November 31, 2021, were investigated. Factors examined were age, gender, marital status, Body Mass Index, Charlson Comorbidity Index, chemotherapy, radiotherapy, tumor stage, grade, site, surgical approach, length of stay, and discharge location. Kaplan–Meier curves were constructed to assess survival rates between readmitted and non-readmitted patients, and logistic regressions were performed to assess predictors of readmission.ResultsA total of 356 patients underwent tumor resection and 49 patients were readmitted within 30-day of index discharge. The most common reasons for hospital readmissions were gastrointestinal (22.45%), urinary tract infection (16.33%), and surgical site infection (12.24%). In the multivariable analysis, females were 89% more likely to be readmitted compared to males (odds ratio 1.89, 95% confidence intervals 1.00–3.58). Patients with distant metastatic tumors have higher odds of readmission (odds ratio 4.52, 95% confidence intervals 1.39–14.71) compared to patients with localized disease.ConclusionsColorectal cancer readmission is more common in patients with metastatic disease. Strategies to reduce readmission include planned transition to outpatient care, especially among patients with a high risk of readmission.

Evaluating the risk of post-operative abscess formation following use of hemostatic agents at time of hysterectomy

ObjectiveAt an academic institution in rural Virginia, we noticed a trend of increased re-admissions for postoperative pelvic abscesses. The primary study objective was to determine if intraoperative use of hemostatic agents (HA) was associated with postoperative abscess formation in patients undergoing hysterectomy. MethodsRetrospective chart review identified women who underwent hysterectomy by a Gynecologic Oncologist for any indication at a single institution from January 1, 2019 through December 31, 2019. Patient and surgical characteristics were abstracted and comparisons were made among those who received any HA and those that did not. The relationship between intraoperative HA use and postoperative pelvic abscess formation was determined using multivariate logistic regression. Secondary outcomes evaluated included the presence of other major post-operative adverse events. Results428 hysterectomies were identified with a postoperative pelvic abscess rate of 3.7 %. Abscesses were identified in 4 (2.2 %) of cases withoutvs12 (4.9 %) of cases with HA use with a logistic regression model demonstrating no significant difference in the groups (OR = 2.10,p = 0.22).Data showed an increase in presentation to the Emergency Department (ED) (OR = 3.43,p = 0.002 adjusted) and higher odds of readmission within 30 days of surgery (OR = 3.19,p = 0.03) with HA use. ConclusionsNo association was found between HA use and abscess formation; however, data showed HA use was associated with increased odds of presentation to the ED and readmission to the hospital within 30 days of surgery.Given the potential negative impact on patient outcomes, use of these products at time of hysterectomy should be made with careful consideration.

Rising Readmission Rates After Diabetic Ketoacidosis Hospitalization Among Adults With Type 1 Diabetes Throughout a Decade in the United States.

Research on longitudinal trends in readmission rates after diabetic ketoacidosis (DKA) is lacking. This retrospective study was aimed at identifying trends in readmissions after hospitalization for DKA, as well as trends in outcomes after readmission, over time among adults with type 1 diabetes in the United States. Findings indicate that the DKA readmission rate increased from 53 to 73 events per 100,000 between 2010 to 2018, and low-income and uninsured patients had higher odds of readmission. There was no significant change in mortality after readmission over time. Improved access to care and affordable management options may play a crucial role in preventing readmissions.

Causes and predictors of immediate and short-term readmissions following percutaneous left atrial appendage closure procedure.

Percutaneous left atrial appendage device closure has been offered as an alternative to anticoagulation for high-risk patients with nonvalvular atrial fibrillation. Given the relative novelty of the procedure, we aimed to analyze the rates and causes of immediate (30 days) and short-term (90 days) readmission after the procedure. We performed a retrospective observational study using the Nationwide Readmissions Database for 2018. We studied 29 449 hospitalizations for percutaneous left atrial appendage (LAA) device closure. In both the 30- and 90-day cohorts, the most common causes of readmissions were gastrointestinal bleeding (16.1% and 14.8%), heart failure exacerbation (11.1% and 11.6%), and atrial fibrillation (6.2% and 7.2%). Female sex, liver disease, chronic kidney disease, chronic pulmonary disease, presence of heart failure,human immunodeficiency virus/acquired immunodeficiency syndrome status, and diabetes mellitus were independently associated with higher odds of readmission in both cohorts. Our study highlights the need for further deliberation on the choice and duration of anticoagulation periprocedurally after percutaneous LAA closure, especially among those with high bleeding risk. It also highlights the need for optimization of heart failure status periprocedurally to avoid readmissions for exacerbations.

Emergency readmissions following geriatric ground-level falls: How does frailty factor in?

BackgroundGround-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients. Materials and MethodsThis is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics. ResultsA total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74–87] vs. 83[76–89] years; p<0.001) and less severely injured–Injury Severity Score [ISS] (4[1–9] vs. 5[2–9]; p<0.001). Frail patients had a higher index mortality (2.9% vs. 1.9%; p<0.001) and higher 30-day readmissions (14.0% vs. 9.8%; p<0.001). Readmission mortality was also higher in the frail group (15.2% vs. 10.9%; p<0.001), with 75.2% of those patients readmitted from an SNF. On multivariate analysis, frailty was associated with 30-day mortality (OR 1.75; p<0.001) and 30-day readmission (OR 1.49; p<0.001). ConclusionFrail geriatric patients are at 75% higher odds of mortality and 49% higher odds of readmission following GLFs. Of those readmitted on an emergency basis, more than one in seven patients died, 75% of whom were readmitted from an SNF. This underscores the need for optimization plans that extend to the post-discharge period to reduce readmissions and subsequent high-impact consequences.

100. Disparities in elective spine surgery for Medicaid beneficiaries: a systematic review

<h3>BACKGROUND CONTEXT</h3> With Medicaid expansion being one of the major provisions of the Affordable Care Act, the number of patients under Medicaid is higher than ever. Nonetheless, Medicaid beneficiaries have been shown to be disadvantaged in health care access and outcomes, particularly within surgical specialties. Understanding and mitigating these inequities is critical for the ability of spine surgeons to provide better care for their patients. <h3>PURPOSE</h3> We sought to synthesize the literature investigating the disparities that Medicaid patients sustain with regard to two types of elective spine surgery: lumbar fusion (LF) and anterior cervical discectomy and fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> Systematic review. <h3>METHODS</h3> Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses (PRISMA) guidelines and protocol. We systematically searched PubMed, Embase, Scopus, CINAHL, and Web of Science databases. We included studies comparing Medicaid beneficiaries to other payer categories with regard to rates of LF and ACDF, costs/reimbursement, and health outcomes. Two independent reviewers performed title and abstract screening followed by full-text review. In both cases, a third reviewer served as an arbiter in cases of disagreement. Additionally, references cited by included articles were also screened for inclusion. The two primary reviewers utilized the methodological index for non-randomized studies (MINORS) criteria to evaluate the quality of included studies. <h3>RESULTS</h3> A total of 573 articles were assessed. Twenty-five articles were included in the analysis. All articles were relatively recent with year of publication ranging from 2016 to 2021. MINORS scores ranged from 18 to 22, indicating moderate to good quality of all studies. We found that the overwhelming majority of research detected significant disadvantages associated with Medicaid insurance. Medicaid was strongly associated with decreased access to LF and ACDF, lower reimbursement rates, and worse health outcomes compared to other insurance types. These findings were replicated in large database studies, multicenter studies, and single institution studies. Worse health outcomes included prolonged length of stay, lower satisfaction and outcome scores, higher pain scores, and higher odds of readmission, emergency department visits, surgical site infections, prolonged opioid use and reintubation. <h3>CONCLUSIONS</h3> In adult patients undergoing elective spine surgery, Medicaid insurance is associated with wide disparities with regard to access to care and health outcomes. The decreased access to health care and the lower reimbursement rates we found highlight the reluctance of health care systems to increase Medicaid coverage. Additionally, the worse health outcomes indicate the need for efforts focused on identifying causes and interventions for disparities in this vulnerable population. With the increasing importance of spine surgery for the aging population, our findings warrant close examination of the roots of inequities in spine surgery to produce interventions that can ameliorate them. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

173-OR: Associations between Post-Discharge Care (PDC) and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults with Diabetes

Cognitive Impairment (CI) is associated with an increased risk of ketoacidosis (DKA) and severe hypoglycemia (SH) in persons with diabetes (DM) . Post-discharge Care (PDC) in nursing homes and home care facilities provides continuous medical care after hospital discharges. This study examined whether PDC is associated with lower CI-related hospital readmission for DKA and SH in US adults with DM (age &amp;gt;18) . Our study population includes 43,467 and 166,221 adults admitted for DKA and SH from the 2016-2018 National Readmission Database, among which 1492 (3.43%) and 822 (0.49%) had CI, respectively. Readmission was defined as hospitalization for all causes within 30 days after discharge. CI-related readmission risk was estimated by comparing those with and without CI using a multiple logistic regression model, adjusting for age, sex, primary payer, income level, disease severity, mortality risk at the index discharge, and PDC status. PDC as an effect modulator was tested as an interaction term of PDC and CI. For patients initially admitted for DKA, CI was associated with 62% (adjusted odds ratio (aOR) =1.62, 1.25-2.11) higher odds of readmission among those who were discharged to home. The CI-related increase in readmission risk disappeared if patients received PDC (aOR=1.05, 0.88-1.26) . For patients initially admitted for SH, CI was associated with 34% (aOR=1.34, 95% CI 1.08-1.66) higher odds of readmission among those discharged to home and a 32% lower odds of readmission if patients received PDC (aOR=0.68, 0.59-0.81) . CI was associated with increased readmission risks for SH and DKA among adults with DM discharged to home. This CI-related readmission risk was substantially lower in patients who received PDC, indicating the importance of PDC for people with DM and CI. Disclosure Y.Wang: None. P.Zhang: None. R.R.Fang: None. J.D.Brown: None. T.Jiao: None. J.Guo: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19

COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of...

Abstract 257: Appraisal Of The Modified Lace Score In Heart Failure Admissions

Background: Medicare’s Hospital Readmissions Reduction Program has focused on reducing the readmission rate in patients admitted for heart failure exacerbations. The LACE score has shown moderate to high predictive value in 30-day readmission and has been validated in heart failure cohorts. We sought to assess the utility of the LACE score in patients admitted for acute myocardial infarctions (AMI). Methods: The National Readmission Database was queried for 2016 and 2019 for adults admitted for acute myocardial infarctions. Patients were stratified by their modified LACE (mLACE) score index, substituting emergency department visits for prior admissions. Trends in 30-day readmission and healthcare utilization were analyzed. Results: Between 2016 and 2019, 2,018,837 patients were admitted for AMI. Stratified by mLACE score, 5.87% (n=118,634) were low-risk, 61.53 were moderate-risk (n=1,242,207), and 32.60% (n=657,997) were high-risk. Readmissions within 30 days occurred in 5.33%, 7.15%, and 14.99% for low, moderate, and high risk, respectively. The Kaplan Meier readmission curve is presented in Figure 1. Multivariate logistic regression showed moderate-risk had 16.60% higher odds of readmission, while high-risk had 77.16% higher odds of readmission. Length of stay (LOS) was 0.81 days for low risk, 2.92 days for moderate risk, and 8.40 days for high risk. Regression analysis showed LOS risk increased 63% for moderate-risk and was 6.16 times higher in high-risk admissions. Total cost was higher by $17,947 and $73,826 in moderate and high risk, respectively. Conclusion: The modified LACE index provides a feasible and cost-effective measurement of risk for readmission, mortality, and healthcare utilization. Patients with a high modified LACE index should be assessed for increased requirements upon discharge and readmission mitigation techniques