Independent Predictors Of 30-day Readmission Research Articles

Causes and Predictors of 30-Day Readmission in Patients With Stroke Undergoing Mechanical Thrombectomy: A Large Single-Center Experience.

The 30-day readmission rate has emerged as a metric of quality care and is associated with increased health care expenditure. We aim to identify the rate and causes of 30-day readmission after mechanical thrombectomy and provide the risk factors of readmission to highlight high-risk patients who may require closer care. This is a retrospective study from a prospectively maintained database of 703 patients presenting for mechanical thrombectomy between 2017 and 2023. All patients who presented with a stroke and underwent a mechanical thrombectomy were included in this study. Patients who were deceased on discharge were excluded from this study. Our study comprised 703 patients, mostly female (n = 402, 57.2%) with a mean age of 70.2 years ±15.4. The most common causes of readmission were cerebrovascular events (stroke [n = 21, 36.2%], intracranial hemorrhage [n = 9, 15.5%], and transient ischemic attack [n = 1, 1.7%]).Other causes of readmission included cardiovascular events (cardiac arrest [n = 4, 6.9%] and bradycardia [n = 1, 1.7%]), infection (wound infection postcraniectomy [n = 3, 5.2%], and pneumonia [n = 1, 1.7%]). On multivariate analysis, independent predictors of 30-day readmission were history of smoking (odds ratio [OR]: 2.2, 95% CI: 1.1-4.2) P = .01), distal embolization (OR: 3.2, 95% CI: 1.1-8.7, P = .03), decompressive hemicraniectomy (OR: 9.3, 95% CI: 3.2-27.6, P < .01), and intracranial stent placement (OR: 4.6, 95% CI: 2.4-8.7) P < .01). In our study, the rate of 30-day readmission was 8.3%, and the most common cause of readmission was recurrent strokes. We identified a history of smoking, distal embolization, decompressive hemicraniectomy, and intracranial stenting as independent predictors of 30-day readmission in patients with stroke undergoing mechanical thrombectomy.

Abstract 12679: Thirty-Day Readmissions for Recurrent Ventricular Tachycardia Following Catheter Ablation of Ventricular Tachycardia: Predictors and Outcomes

Background: Despite the optimal efficacy of catheter ablation for ventricular tachycardia (VT), recurrence of VT can occur post-procedurally. However, data on the high-risk population for VT recurrence and the in-hospital outcomes remain scarce. Objective: This study aimed to determine the predictors of 30-day readmission for recurrent VT after catheter ablation of VT and assess the in-hospital outcomes. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, we identified the patients aged ≥18 years who underwent catheter ablation for VT and were readmitted within 30 days because of recurrent VT from 2017 to 2020. We performed unweighted univariable and multivariable analyses to determine the outcomes and to identify the patient and hospital variables that were predictive of 30-day readmissions for recurrent VT. A p-value of &lt;0.05 is considered statistically significant. Results: In our analysis, a total of 4,102 patients were discharged alive after VT ablation, of which 278 (6.8%) were readmitted within 30 days for recurrent VT. Recurrent VT was also the most common cause of 30-day readmission (47.7%, n=278/583). Compared to non-recurrent VT readmission, readmission due to recurrent VT had higher mortality during rehospitalization (7.55% vs 3.72%, p&lt;0.01) and higher cumulative hospitalization cost ($57584 vs $37846, p&lt;0.01). Via multivariable analysis, congestive heart failure (aOR: 1.84; 95% CI: 1.07-3.17; P=0.03) and non-elective index admissions (aOR: 1.88; 95% CI: 1.32-2.68; P&lt;0.01) were the independent predictors of 30-day readmission for recurrent VT. Conclusion: Recurrent VT was the most common cause of 30-day readmission following VT ablation. Congestive heart failure and non-elective index admissions were the independent predictors of 30-day readmissions for recurrent VT. These highlight the importance of further research in ablation strategies to improve the efficacy of VT ablation.

Hospitalization and readmission after single-level fall: a population-based sample

BackgroundSingle-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older.MethodsWe conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge.ResultsOf 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually.ConclusionsSLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.

Clinical outcomes and predictors for 30-day readmissions of endoscopic retrograde cholangiopancreatography in the United States.

We aimed to assess 30-day readmissions of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. The National Readmission Database was utilized from 2016 to 2020 to identify 30-day readmissions of ERCP. Hospitalization characteristics and outcomes were compared between index hospitalizations and readmissions. Predictors of 30-day readmission and mortality were also identified. Between 2016 and 2020, 885 416 index hospitalizations underwent ERCP. Of these, 88 380 (10.15%) were readmitted within 30days. Compared to index hospitalizations, 30-day readmissions had higher mean age (63.76 vs 60.8years, P<0.001) and proportion of patients with Charlson Comorbidity Index (CCI) score ≥3 (48.26% vs 29.91%, P<0.001). Sepsis was the most common readmission diagnosis. Increasing age, male gender, higher CCI scores, admissions at large metropolitan teaching hospitals, cholecystectomy on index hospitalization, biliary stenting, increasing length of stay (LOS) at index admission, post-ERCP pancreatitis, post-ERCP hemorrhage, and gastrointestinal tract perforation were independent predictors of 30-day readmissions. Furthermore, 30-day readmissions had higher odds of inpatient mortality (4.42% vs 1.66%, aOR 1.9, 95% CI: 1.79-2.01, P<0.001) compared to index hospitalizations. However, we noted a shorter LOS (5.78 vs 6.22days, mean difference 1.2, 95% CI: 1.12-1.28, P<0.001) and lower total hospital charge ($71 076 vs $93 418, mean difference $31 452, 95% CI: 29 835-33 069, P<0.001) for 30-day readmissions compared to index hospitalizations. Increasing age, higher CCI scores, increasing LOS, biliary stenting, and post-ERCP hemorrhage were independent predictors of inpatient mortality for 30-day readmissions. After index ERCP, the 30-day remission rate was 10.15%. Compared to index hospitalizations, 30-day readmissions had higher odds of inpatient mortality.

Healthcare and economic burden of heart failure with amyloidosis: An insight from National Readmission Database

IntroductionWe analyzed trends, causes and predictors of 30-days readmission in cardiac amyloidosis and inspected the impact of these readmissions on mortality, morbidity, and utilization of healthcare resources. MethodsHeart Failure with cardiac amyloidosis patients were selected from National readmission Database (NRD) using ICD-10 CM codes. Patients younger than 18 years, elective readmissions, readmissions due to trauma, patients with missing data and December 2018 admissions were excluded. Primary outcome was all-cause 30-day readmissions rate, secondary outcomes were factors associated with 30-days readmissions and their effect on morbidity, mortality, and healthcare resource utilization. ResultsOut of 4123 total heart failure with cardiac amyloidosis index admissions in 2018, 3374 patients were included in final analysis. 19.6% were readmitted within 30 days. Readmitted patients were younger, sicker, admitted to small or large hospital. Hypertensive heart and Chronic Kidney Disease (CKD Stage I-IV) with Congestive Heart Failure (CHF), hypertensive heart and CKD (Stage V) or End Stage Renal Disease (ESRD) with CHF, hypertensive heart disease with CHF, acute kidney failure, and sepsis were the most common causes of readmissions. Young age, admission to small and large size hospitals were independent predictors of 30-day readmissions. Readmissions had higher mortality, costed 6.6 extra in hospital days to patients and $16380 per admission to healthcare system. ConclusionsCardiac amyloidosis readmissions were associated with increased morbidity and mortality of patients and extra burden on the healthcare system. There is a need to identify patients at risk for readmissions to improve patient outcomes and decrease healthcare cost.

Thirty-day readmission after catheter ablation for ventricular tachycardia: associated factors and outcomes.

Patients with ventricular tachycardia (VT) who require VT ablation are at high risk for readmission. This study aimed to identify the causes and outcomes of 30-day readmission after VT ablation and to analyze the predictors of recurrent VT that required rehospitalization. Using the Nationwide Readmission Database, our study included patients aged ≥ 18years who underwent VT catheter ablation between 2017 and 2020. Based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), we identified the causes of 30-day readmission by organ systems and analyzed their outcomes. Additional analysis was performed to determine the independent predictors of 30-day readmission for recurrent VT. Of the 4228 patients who underwent VT ablation, 14.2% were readmitted within 30days of the procedure. The most common cause of readmission was cardiac events (73.6%). Among the cardiac-related readmissions, recurrent VT (47.7%) and congestive heart failure (CHF) (12.9%) were the most common etiologies. Among the readmissions, patients readmitted for CHF had the highest rate of readmission mortality (9.2%). Of the patients readmitted within 30days of the procedure, 278 patients (6.8%) were readmitted for recurrent VT. Via multivariable analysis, CHF (OR: 1.97; 95% CI: 1.12-3.47; P = 0.02) and non-elective index admissions (OR: 1.63; 95% CI: 1.04-2.55; P = 0.03) were identified as the independent predictors predictive of 30-day readmissions for recurrent VT. Recurrent VT was the most common cause of readmission after the VT ablation procedure, and CHF and non-elective index admissions were the significant predictors of these early readmissions. Readmission due to CHF had the highest mortality rate during readmission.

Independent Predictors of 30-Day Readmission to Acute Psychiatric Wards in Patients With Mental Disorders: A Systematic Review and Meta-Analysis.

Psychiatric readmissions have long been considered significant indicators for healthcare planning. The aim of this study was to identify factors influencing early (30-day) readmissions to acute psychiatric wards. A meta-analysis and systematic review were conducted according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Comprehensive database searching was conducted using online databases, including PubMed and Google Scholar, to search for articles identifying factors associated with early (30-day) readmissions to acute psychiatric wards. Keywords used to search for relevant articles included"Mental illness," "readmission," and factors along with their synonyms and Medical Subject Headings (MeSH) terms. The search included studies published between 2011 and June 2023. A total of 13 studies were included in this meta-analysis.The pooled rate of the 30-dayreadmission was16% (95% confidence interval: 13%-20%). A pooled analysis showed that factors significantly associated with an unplanned hospital readmission included gender, length of stay, and insurance status as predictors of the unplanned hospital readmission among individuals with psychiatric illness. Additionally, we also found that the rate of 30-day unplanned admissions was greater in patients with schizophrenia, followed by personality disorder, bipolar disorder, depression, and substance use.This study highlights the importance of providing targeted interventions and support for individuals with these conditions to reduce the risk of readmissions.

A risk score to predict 30-day hospital readmission rate in cirrhotic patients with spontaneous bacterial peritonitis

Background and aimThere is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP.MethodsThis study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission.ResultsOf 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/dL) were found to be independent predictors of 30-day readmission. Incorporating these predictors, Mousa readmission score was established to predict 30-day patient readmissions. ROC curve analysis demonstrated that at a cutoff value ≥ 4, Mousa score had optimum discriminative power for predicting the readmission in SBP with sensitivity 90.6% and specificity 92.9%. However, at cutoff value ≥ 6 the sensitivity and specificity were 77.4% and 99.7%, respectively, while a cutoff value ≥ 2 had sensitivity of 99.1% and specificity of 31.6%.ConclusionsThe 30-day readmission rate of SBP was 25.6%. With the suggested simple risk assessment Mousa score, patients at high risk for early readmission can be easily identified so as to possibly prevent poorer outcomes.

Hypothyroidism as an Independent Predictor of 30-day Readmission in Head and Neck Cancer Patients.

To define the role of hypothyroidism and other risk factors for unplanned readmissions after surgery for head and neck cancer. Retrospective cohort study. The Nationwide Readmission Database (NRD) was used to identify patients who underwent surgery for mucosal head and neck cancer (oral cavity, oropharynx, larynx, and hypopharynx) between 2010 and 2017. Univariate and multivariate logistic regression were performed to determine patient, tumor, and hospital related risk factors for 30-day readmission. Readmitted patients were stratified by preoperative diagnosis of hypothyroidism to compare readmission characteristics. For the 131,013 patients who met inclusion criteria, the readmission rate was 15.9%. Overall, 11.91% of patients had a preoperative diagnosis of hypothyroidism. After controlling for other variables, patients with a preoperative diagnosis of hypothyroidism had 12.2% higher odds of readmission compared to those without hypothyroidism (OR: 1.12, 1.03-1.22, p = 0.008). Patients with hypothyroidism had different reasons for readmission, including higher rates of wound dehiscence, fistula, infection, and electrolyte imbalance. Among readmitted patients, the length of stay for index admission (mean 10.5 days vs. 9.2 days, p < 0.001), readmission (mean 7.0 vs. 6.6 days, p = 0.05), and total hospital charge were higher for hypothyroid patients ($137,742 vs. $119,831, p < 0.001). Hypothyroidism is an independent risk factor for 30-day readmission following head and neck cancer resection. Furthermore, hypothyroid patients are more likely to be readmitted for wound complications, infection, and electrolyte imbalance. Targeted interventions should be considered for hypothyroid patients to decrease readmission rates and associated patient morbidity, potentially leading to earlier initiation of adjuvant treatment. 3 Laryngoscope, 133:2988-2998, 2023.

Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate.

Holmium enucleation of the prostate (HoLEP) is becoming the gold standard for the treatment of benign prostatic hyperplasia (BPH). Our objective was to identify predictors of 30-day readmission and the impact of same-day discharge after HoLEP. Using NSQIP data from 2011 to 2019, we identified men who underwent HoLEP for the treatment of BPH. We compared patients based on time of discharge and readmission status. We used multivariable logistic regression analysis (MLRA) to identify independent factors associated with 30-day readmission. A total of 3,489 patients met inclusion criteria with 833 (23.88%) being discharged within 24hours and 2,656 (76.12%) discharged after 24hours. There were 158 (4.53%) 30-day readmissions, mostly due to hematuria and urinary tract infection. Patients being readmitted were older (72 vs. 70years old, P=0.001), were more likely to have preoperative anemia (36.7% vs. 23.1%; P<0.001), chronic kidney disease (29.7% vs. 19.7%; P<0.001), bleeding disorder (10.8% vs. 2.8%; P<0.001), higher American Society of Anesthesiologists (ASA) scores (≥3: 70.3% vs. 46.7%; P<0.001) and a higher frailty burden (5-item modified frailty index [5i-mFI]≥2: 36.1% vs. 19.1%; P<0.001) compared to their counterparts. Factors independently associated with 30-day readmission were bleeding disorder (OR 2.89; 95% CI 1.63-5.11; P<0.001), 5i-mFI ≥ 2 (OR 1.67; 95% CI 1.03-2.71; P=0.038) and an ASA score ≥3 (OR 1.80; 95% CI 1.21-2.70; P=0.004); however, same-day discharge was not found to be a significant predictor of 30-day readmissions. The overall readmission rate after HoLEP is low. Patients discharged within 24hours have similar rates of readmission compared to patients discharged after 24hours. We found bleeding disorder, frailty burden, and ASA score to be independent predictors of 30-day readmission.

Association of hospital volume with postoperative outcomes in Crohn's disease.

Most patients diagnosed with Crohn's disease (CD) require surgery during their lifetime. While the literature has shown that certain cancer patients have superior postoperative outcomes at high-volume hospitals, there remains a paucity of data on the hospital volume-outcome relationship in CD. Given the complexities in both medical and surgical management, this study aims to determine whether patients with CD have superior postoperative outcomes at high-volume hospitals. A retrospective analysis of patients undergoing abdominal surgery for CD in New York hospitals between 2012 and 2018 was performed using data from the Statewide Planning and Research Cooperation System. Outcomes included postoperative mortality, 30-day readmission and postoperative complications. Using a penalized B-spline plot, high-volume centres were defined as those performing more than 160 abdominal surgeries for CD each year. A total of 13,221 surgeries were performed across 176 hospital centres in New York State. Of these, 73.9% of procedures occurred at low-volume centres. High-volume hospitals had lower in-hospital mortality (0.5% vs. 1.5%; p< 0.001) and 30-day readmission rates (8.3% vs. 10.4%; p< 0.001) than low-volume centres. Major postoperative complications and reoperation rates did not differ by hospital volume. On multivariate analysis, patients at high-volume hospitals had lower odds of in-hospital mortality (OR 0.54, 95% CI 0.38-0.75) and 30-day readmission (OR 0.79, 95%CI 0.64-0.98). Hospital volume remained an independent predictor of 30-day readmission for emergent admissions (OR 0.72, 95% CI 0.61-0.85) and in-hospital mortality for nonemergent admissions (OR 0.39, 95% CI 0.19-0.82). Patients undergoing abdominal surgery for CD have lower odds of postoperative mortality and 30-day readmission when the operation occurs at a high-volume hospital. These findings suggest that surgical patients with CD may benefit from care at specialized centres.

Abstract 11590: Impact of Adverse Social and Behavioral Determinants of Health on In-Hospital Mortality Following an Acute Atherosclerotic Vascular Event at a Safety Net Community Hospital

Introduction: Safety net community hospitals (SNCH) care for patients with disproportionately high prevalence of adverse social and behavioral determinants of health (SBDH). We evaluated the impact of adverse SBDH on in-hospital mortality and 30-days readmission after a first atherosclerotic cardiovascular disease (ASCVD) event at a large urban SNCH. Methods: We performed a retrospective review of patients presenting with an ASCVD event (coronary heart disease, cerebrovascular disease, or peripheral artery disease) between 2015 and 2019. Adverse SBDH was defined as history of homelessness, mental illness, incarceration, or substance use disorder. We used logistic regression analysis to evaluate independent predictors of in-hospital mortality and 30-day readmission following ASCVD event. Results: A cohort of 1974 patients was identified, mean age 63.8 years with standard deviation (SD) of 14.5, patients with adverse SBDH were 8 years younger than those without any adverse SBDH (58.5 years,SD:12 vs. 66 years,SD:14.8; p&lt;0.0001). Atleast one adverse SBDH was noted in 28% of the cohort. Using multivariable analysis, presence of SBDH was not an independent predictor of in-hospital mortality or 30-day readmission following ASCVD event. Age above 65 years tripled the likelihood of in-hospital mortality. Black race and age above 45 years were independent predictors of 30-days readmission. Patients on aspirin and antihypertensives prior to admission were less likely to die in the hospital (Table 1). Conclusions: In this cohort from a SCNH with 28% prevalence of adverse SBDH, the presence of any adverse SBDH did not impact in-hospital mortality or 30-day readmission. However, notably, patients with adverse SBDH presenting with an index ASCVD event were about a decade younger than those without adverse SBDH.

Abstract 11439: Predictors of Long-Term Heart Failure Readmissions Following PCI in Women

Introduction: Heart failure (CHF) is a common cause of readmission following percutaneous coronary intervention (PCI), particularly within the first 30 days. Female sex has been shown to be an independent predictor of 30-day readmission following PCI, with higher rates of readmission secondary to CHF observed in women. Whether the increased risk for CHF readmission persists beyond this early period has not been well studied. Methods: In this multicenter, retrospective observational study clinical outcomes were analyzed after PCI among patients included in the Indiana University Health Multicenter Cath Registry Study. Hospital readmission for acute CHF was the primary endpoint and analyzed through use of the Indiana network for patient care. Results: Among 13,871 patients included in this study, 14.5% were readmitted for CHF after the index PCI during mean follow up of 2.8 years. Women (n=4,411) were more likely to be readmitted for CHF than men (n=9,460) [HR 1.37,95% CI: 1.26-1.5; p&lt;0.001). Women were older than men (66.1 vs. 63.8 years, p&lt;0.001) and more likely to have diabetes (49% vs. 41%, p&lt;0.001). Female sex persisted as independent predictor of CHF readmission after multivariate adjustment (p=0.004). The higher rate of CHF readmission in women continued to accrue beyond 30 days and event curves continued to diverge over the duration of follow up (Fig.).] Major predictors of CHF readmission included end stage renal disease, cardiogenic shock during index PCI, mechanical ventricular support at time of PCI, diabetes mellitus, and history of COPD, whereas discharge with ACEI or ARB was protective. Conclusions: Heart failure readmission remains a major cause of morbidity for women after undergoing PCI. The excess risk of CHF readmission in women extends beyond the early 30-day post PCI period.

Abstract 13781: Same-Day Discharge After Transcatheter Mitral Valve Repair: Propensity Score-Matched Analysis From the Nationwide Readmissions Database 2014-2019

Introduction: Transcatheter mitral valve repair (TMVR) has evolved over the years, and early discharge strategies are being increasingly adopted. However, there is paucity of data on the outcomes and safety of same-day discharge (SDD) after TMVR. Methods: Data from the Nationwide Readmissions Database 2014 to 2019 were analyzed. International Classification of Diseases codes were used to identify adult patients admitted for elective TMVR. Patients who underwent uncomplicated TMVR were identified by excluding patients with periprocedural complications such as bleeding, vascular access site complications, pericardial complications, stroke, myocardial infarction, shock, or death before discharge. A 1:3 propensity score-matched analysis was performed to compare outcomes of patients undergoing SDD and different-day discharge (DDD). The primary outcome of interest was the 30-day unplanned readmission rate. Results: We identified 34,683 patients who received complication-free TMVR, of which 232 (0.67%) underwent SDD. There was a gradually rising trend of SDD after TMVR over the study period. The baseline characteristics of the unmatched and propensity-matched SDD and DDD groups are shown. Patients in SDD group did not have a significantly higher 30-day readmission rate (15.7% vs 14.8%, p = 0.82) compared to DDD group, but had significantly lower mean hospitalization costs ($33,060 vs $41,134, p &lt;0.001). Female gender, diabetes, chronic kidney or pulmonary disease, anemia, liver disease, cancer and atrial fibrillation were found to be independent predictors of 30-day readmissions after TMVR (shown in figure). Conclusions: Patients receiving a complication-free TMVR who were discharged on the same day as the procedure had a similar 30-day unplanned readmission rate compared with those that stayed in the hospital longer. Our findings suggest that same-day discharge after uncomplicated TMVR may be a safe and cost-effective strategy in selected patients.

Rates, Reasons, and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations in the USA.

Portal vein thrombosis (PVT), generally considered rare, is becoming increasingly recognized with advanced imaging. Limited data exist regarding readmissions in PVT and its burden on the overall healthcare cost. This study aimed to outline the burden of PVT readmissions and identify the modifiable predictors of readmissions. The National Readmission Database (NRD) was used to identify PVT admissions from 2016 to 2019. Using the patient demographic and hospital-specific variables within the NRD, we grouped patient encounters into two cohorts, 30- and 90-day readmission cohorts. We assessed comorbidities using the validated Elixhauser comorbidity index. We obtained inpatient mortality rates, mean length of hospital stay (LOS), total hospital cost (THC), and causes of readmissions in both 30- and 90-day readmission cohorts. Using a multivariate Cox regression analysis, we identified the independent predictors of 30-day readmissions. We identified 17,971 unique index hospitalizations, of which 2,971 (16.5%) were readmitted within 30 days. The top five causes of readmissions in both 30-day and 90-day readmission cohorts were PVT, sepsis, hepatocellular cancer, liver failure, and alcoholic liver cirrhosis. The following independent predictors of 30-day readmission were identified: discharge against medical advice (AMA) (adjusted hazard ratio (aHR) 1.86; P = 0.002); renal failure (aHR 1.44, P = 0.014), metastatic cancer (aHR 1.31, P = 0.016), fluid and electrolyte disorders (aHR 1.20, P = 0.004), diabetes mellitus (aHR 1.31, P = 0.001) and alcohol abuse (aHR 1.31, P ≤ 0.001). The readmission rate identified in this study was higher than the national average and targeted interventions addressing these factors may help reduce the overall health care costs.

Early readmissions of spontaneous bacterial peritonitis in the USA: Insights into an emerging challenge.

Early readmissions of spontaneous bacterial peritonitis (SBP) are often associated with poor outcomes. We compared characteristics and outcomes for index and 30-day readmissions of SBP in the USA. We analyzed the Nationwide Readmissions Database for 2018 to identify all adult (≥18years) 30-day readmissions of SBP in the USA. Hospitalization characteristics and outcomes for index and 30-day readmissions of SBP were compared. Independent predictors of 30-day readmissions were also identified. In 2018, of the 5,797 index admissions for SBP, 30% (1726) were readmitted within 30day. At the time of readmission, the most common admitting diagnosis was alcoholic cirrhosis of the liver with ascites (11.8%) followed by sepsis due to an unspecified organism (9.2%). SBP as an admitting diagnosis was identified for only 8.3% of these 30-day readmissions. Compared with index admissions, 30-day readmissions of SBP had a lower mean age (56.1 vs 58.6years, P<0.001) without a statistically significant difference for gender. Furthermore, 30-day readmissions of SBP were associated with significantly higher odds of inpatient mortality (10% vs 4.9%, OR: 2.15, 95% CI: 1.66-2.79, P<0.001), and mean total hospital charge ($85,031 vs $56,000, mean difference: 29,032, 95% CI: 12,867-45,197, P<0.001) compared with index admissions. The presence of chronic pulmonary disease, liver failure, inpatient dialysis, and discharge against medical advice were identified as independent predictors for increased 30-day readmissions of SBP. The 30-day readmission rate of SBP was 30% and these readmissions were associated with higher odds of inpatient mortality compared with index admissions.

Predictors, timing, causes and cost of 30-day readmission after acute ischemic stroke: insights from a Chinese cohort 2015-2018

ABSTRACT Background This study aims to empirically investigated the risk factors, timing, and cost of the 30-day readmission after ischemic stroke. Methods We used the administrative claims data with 18,983 in-patients of ischemic stroke from 2015 to 2018 of a supercity in western China. The test was used in univariate analysis. A multivariate cox model and a multivariate linear regression method were used to identify those predictors of the 30-day readmission and the cumulative cost, respectively. Results The overall 30-day readmission rate was 18.8%, of which 36.4% and 60.9% were readmitted within 7 and 14 days, respectively. Nearly 50% were readmitted for recurrent ischemic stroke. Male, rural areas, aged under 50, resident’s insurance scheme, primary hospitals, LOS under 1 week or over two weeks, and comorbidities including congestive heart failure, solid tumor, fluid and electrolyte disorders, and depression were independent predictors of 30-day readmission. We also found that the 30-day readmission was associated with an 76% increase in the cumulative hospitalization cost (P < 0.001) after multivariate adjustment analysis. Conclusions The findings highlight the importance of the readmission of ischemic stroke and corresponding policies and interventions, and our work could provide a potential manage path for the reduction of readmission rate.

Perioperative Risk Stratification Model for Readmission after Panniculectomy.

Readmission is an important metric for surgical quality of care. This study aimed to develop a validated risk model that reliably predicts readmission after panniculectomy using the American College of Surgeons National Surgical Quality Improvement Program database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients who had undergone panniculectomy from 2005 to 2018. The outcome of interest was 30-day readmission. The cohort was divided randomly into 70 percent development and 30 percent validation groups. Independent predictors of 30-day readmission were identified using multivariable logistic regression on the development group. The predictors were weighted according to beta coefficients to generate an integer-based clinical risk score predictive of readmission, which was validated against the validation group. For the model selection, 22 variables were identified based on criteria of p < 0.05 percent and complete data availability. Variables included in the development model included inpatient surgery, hypertension, obesity, functional dependence, chronic obstructive pulmonary disease, wound class greater than or equal to 3, American Society of Anesthesiologists class greater than 3, and liposuction. Receiver operating characteristic curve analysis of the validation group rendered an area under the curve of 0.710, which demonstrates the accuracy of this prediction model. The predicted incidence within each risk stratum was statistically similar to the observed incidence in the validation group ( p < 0.01), further highlighting the accuracy of the model. The authors present a validated risk stratification model for readmission following panniculectomy. Prospective studies are needed to determine whether the implementation of the authors' clinical risk score optimizes safety and reduces readmission rates. Risk, III.

Anemia And Other Independent Predictors Of 30-day Readmissions In Heart Failure Patients: A Retrospective Study

<h3>Objectives</h3> To determine if there is an association between anemia and 30-day readmissions in patients with heart failure, and to identify other risk factors for 30-day readmissions in this group. <h3>Background</h3> : Anemia commonly occurs in patients with chronic heart failure, with a prevalence of up to 79%. It can be explained by the presence of comorbidities, chronic kidney disease, and differences in heart failure treatment. Anemia is likely associated with worse clinical outcomes in those patients because of a mismatch in oxygen supply and demand, increased resistance to erythropoietin, higher rates of left ventricular hypertrophy and fluid overload, and chronic inflammation. Findings associated with anemia in heart failure patients include symptoms, echocardiogram measurements, renal function, mortality, hospitalization rates and lengths of hospital stays. Few studies, however, have assessed the association of anemia with 30-day readmission rates in these patients. <h3>Methods</h3> : We conducted a retrospective chart review of patients with heart failure admitted to Ascension St John Hospital in Michigan from 1/1/2018 to 12/31/2019. Data were collected on demographics, comorbidities, laboratory testing during the index hospitalization, echocardiogram findings, and 30-day readmissions. Anemia was defined as hemoglobin less than 13 g/dL in males and hemoglobin less than 12 g/dL in females. Data were analyzed using Student's t-test, the χ2 test and logistic regression. <h3>Results</h3> : We reviewed 1250 patients with heart failure, 58.2% male, 52.6% non-white, mean age 68.2 ± 15.3 years. Of those patients, 24.2% (303/1250) were readmitted within 30 days; 55.5% of those readmissions were a result of cardiovascular disease. Anemia was noted in 62.2% of the patients (778/1250). From univariable analysis, the following factors were found to be associated with 30-day readmissions in heart failure patients: anemia (p = 0.008), female sex (p = 0.03), pulmonary edema (p = 0.013), hyponatremia (p = 0.005), atrial fibrillation or flutter (p = 0.04), hyperlipidemia (p = 0.042), antiarrhythmic medications (p < 0.0001), and Charlson Weighted Index of Comorbidity (CWIC) score (p < 0.0001). From multivariable analysis, heart failure patients who were readmitted within 30 days were more likely to be anemic (OR = 1.4, p = 0.029), hyponatremic (OR = 1.5, p = 0.007), have pulmonary edema on chest imaging during the index hospitalization (OR = 1.4, p = 0.033), prescribed antiarrhythmic medications (OR = 1.8, p = 0.002), and have higher CWIC scores (OR = 1.1, p = 0.001). <h3>Conclusions</h3> : In patients with heart failure, after controlling for other risk factors, anemic patients were 40% more likely to be readmitted within 30-days compared to non-anemic patients. Other independent predictors of 30-day readmissions included hyponatremia, pulmonary edema, antiarrhythmic medications, and CWIC score.

36. Clinical Features of and Risk Factors for 30-day Readmission after an Initial Hospitalization with COVID-19

BackgroundLittle is known about risk factors for readmission after COVID-19 hospitalizations. Knowledge of these factors may help to identify patients at increased risk and may help to prevent these rehospitalizations. MethodsThis historical cohort study was conducted at a tertiary care academic medical center. We included COVID-19 cases diagnosed by reverse-transcriptase polymerase-chain-reaction (RT-PCR) assay between March 8th and June 14th, 2020. Patients readmitted within 30 days were identified. Using the electronic medical record, we collected data on demographic and clinical information. Data were analyzed using Student’s t-test, the chi-squared test and multivariable logistic regression.ResultsWe included 391 patients who survived after the index hospitalization for COVID-19. The readmission rate was 13.3% (52/391). The mean time to readmission was 9.2 ± 7.9 days. The mean age (±SD) was 66.3 ± 18.6 years, 44.2% were male, and 78.8% were black/African-American. The most common presenting complaint was shortness of breath (50%). The most frequent diagnosis during the readmission was infectious process (57.7%). The mortality rate on readmission was 11.5%. Patients with a 30-day readmission were older than those not readmitted, mean age (±SD) 66.3 ± 18.6 vs. 61.0 ± 16.0, respectively (p=0.03). Readmitted patients also had a higher prevalence of heart failure and renal disease as comorbidities. Elevated alanine aminotransferase (AST) and low albumin level were also associated with readmission (Table 1). Intensive care unit (ICU) admission or mechanical ventilation during the index admission did not increase the risk of readmission. From multivariable analysis, independent predictors of 30-day readmission were higher Charlson score (p=0.004), higher creatinine on admission in the index hospitalization (p=0.009), and presence of rhabdomyolysis during the index hospitalization (p=0.039) (Table 2).Table 1. Univariable Analysis of Predictors for Readmission within 30 days from COVID-19 Infection Table 2. Multivariable Analysis of Predictors for Readmission within 30 days from COVID-19 Infection ConclusionIn our cohort, infectious etiologies were common among those readmitted within 30 days of COVID-19. A higher Charlson score, acute renal failure, and rhabdomyolysis during the index admission were independent predictors of a 30-day readmission. Further studies are required to investigate these contributing factors.Disclosures All Authors: No reported disclosures