Nonelective Readmission Rate Research Articles

30-Day Readmissions and the Need for Emergency Surgery Following Non-Operative Management of Perforated Diverticulitis.

Background: Limited data are available on the evaluation and outcomes of patients with perforated diverticulitis who were treated without surgery. Aims: This retrospective review was aimed at investigating the 30-day non-elective re-admission rates for patients hospitalized with perforated diverticular disease who were treated without surgery, rates of patients requiring surgery on re-admission, and the independent predictors of re-admission. Methods: A total of 143,546 patients from the National Readmission Database, between 2016 and 2020, who were admitted with perforated diverticulitis and treated non-operatively were reviewed. Re-admitted patients were compared with those not re-admitted. Comparisons for continuous and categoric variables were made using the student t-test and chi-squared test, respectively. A logistic regression model was used to determine independent factors associated with re-admission. All analyses were done with SAS 9.4; p values <0.05 identified significance. Results: Among patients with perforated diverticulitis who were treated non-operatively, 17,868 (12.4%) were re-admitted within 30 days and 4,924 (27.6%) of patients re-admitted required surgical intervention. The greatest independent predictors of re-admission include patient insurance status, index length of stay, undergoing a drainage procedure, and patient disposition. Comorbidities predicting re-admission include renal failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, and hypertension. Hospital total charges were greater at the index admission for patients requiring re-admission. Conclusion: Non-operative management of perforated diverticulitis is safe for many patients, but the risks for re-admission and subsequent need for emergency surgery require special consideration.

Maternal and Fetal Outcomes in Pulmonary Hypertension During Pregnancy: A Contemporary Nationwide Analysis

BackgroundPulmonary hypertension (PH) disproportionately affects women, presenting challenges during pregnancy. Historically, patients with PH are advised to avoid pregnancy; however, recent reports have indicated that the incidence of adverse events in pregnant females with PH may be lower than previously reported. MethodsWe conducted a retrospective cohort study in pregnant patients with PH using the National Readmission Database from January 1, 2016, to December 31, 2020. PH was categorized according to the World Health Organization (WHO) classification. Primary endpoints include maternal mortality and 30-day non-elective readmission rate. Other adverse short term maternal (cardiovascular and obstetric) and fetal outcomes were also analyzed. ResultsAmong 9,922,142 pregnant women, 3,532 (0.04%) had pulmonary hypertension (PH), with Group 1 PH noted in 1,833 (51.9%), Group 2 PH in 676 (19.1%), Group 3 PH in 604 (17.1%), Group 4 PH in 23 (0.7%), Group 5 PH in 98 (2.8%), and multifactorial PH in 298 (8.4%). PH patients exhibited higher rates of adverse cardiovascular events (15.7% vs. 0.3% without PH, p < 0.001) and mortality (0.9% vs. 0.01% without PH, p < 0.001). Mixed PH and Group 2 PH had the highest prevalence of adverse cardiovascular events among WHO PH groups. Patients with PH had a significantly higher non-elective 30-day readmission rate (10.4% vs. 2.3%) and maternal adverse obstetric events (24.2% vs. 9.1%) compared to those without PH (p < 0.001) (Figure 1). ConclusionPregnant women with PH had significantly higher adverse event rates, including in-hospital maternal mortality (85-fold), compared to those without PH.

Diabetes Mellitus and Peripartum Cardiomyopathy: A Nationwide Study

BackgroundThe relationship between diabetes mellitus-(DM) and peripartum-cardiomyopathy(PPCM) remains uncertain. This study aims to clarify the connection between DM and PPCM to predict cardiovascular-outcomes using data from the National Readmission Database(NRD). Methods and ResultsWe analyzed data from 2016-2020 and identified 20,865 hospitalizations for PPCM, with 10.02% (2,091 cases) of them diagnosed with DM. PPCM patients with DM had a higher mean age (36 years,SD-7.6 vs 32 years,SD-6.7;p=0.000). Baseline-comorbidities were shown in Figure1. DM in PPCM has been identified as a predictor for acute-kidney-injury(AKI)[OR 2.38,95%CI 2.01-2.82,p=0.000], and major-adverse-cardiac-and-cerebrovascular-events(MACCE)[OR 1.65,95%-CI 1.32-2.05,p=0.000]. However, it is not associated with an increased risk of death[OR 1.7,95%-CI 1.00-2.99,p=0.048],Stroke[OR 1.24,95%-CI 0.65-2.36,p=0.512],Myocardial infraction[OR 1.56,95%-CI 1.00-2.43,p = 0.051],Suddencardiac-arrest[OR 1.12,95%-CI 0.74-1.69,p=0.603), or the necessity for Mechanical-cardiac-support[OR 1.01,95%-CI 0.59-1.72, p=0.967], Figure-2. Moreover, PPCM patients with DM exhibit an extended mean hospital stay(7.2-vs-5.7 days,p<0.000) and infaltion adjusted-cost of hospitalization ($1,02,690-vs-$84,507,p<0.00). Interestingly, these patients had a lower 30-day non-elective readmission rate (2.3% vs. 8.9%). The top three primary causes of non-elective readmission in the DM group were heart-failure, acute pericarditis, and acute kidney injury. ConclusionsOur findings show that not only do PPCM patients with DM present a higher mean age and increased baseline comorbidities, but they are also at a greater risk for acute kidney injury and significant cardiac and cerebrovascular events. Additionally, these patients undergo extended average hospital stays and incur higher infaltion adjusted hospitalization expenses.

Comparison of Postoperative Outcomes, Costs, and Readmission Between Total and Subtotal Cholecystectomy.

An increasing body of literature supports subtotal cholecystectomy (STC) in the management of patients with difficult gallbladder anatomy; however, large-scale studies examining outcomes of total cholecystectomy and STC are lacking. All adults undergoing total cholecystectomy or STC were tabulated from the 2016-2019 Nationwide Readmissions Database. Entropy balancing was performed to adjust for patient differences based on extent of resection. Subsequent multivariable regression models were used to assess the association of STC with major adverse events, postoperative length of stay (pLOS), hospitalization costs, and 30-day non-elective readmission rates. Of an estimated 854357 patients, 7089 (.8%) underwent STC. Compared to total, STC patients were significantly older, less commonly female, and had a higher Elixhauser Index (all P < .001). Both cohorts had similar rates of postoperative ERCP (1.7% vs 1.5%, P = .33); however, the STC cohort had significantly higher utilization of subsequent drainage procedures (1.8% vs .5%, P < .001). After entropy balancing and multivariable risk-adjustment, STC was not associated with greater odds of MAE (AOR 1.11, 95% CI .99-1.23, P = .06). Notably, relative to total, STC was associated with longer pLOS (β .14, 95% CI .11-.17, P < .001) and greater hospitalization costs (β + $1,900, 95% CI 1300-2,500, P < .001). However, the extent of resection was not associated with the likelihood of 30-day non-elective readmission (AOR 1.01, 95% CI .91-1.13, P = .86). Our findings suggest that STC is a viable, yet resource intensive, option in the management of complex cholecystitis.

Postoperative Complication and Reoperation Rates Following Resection of Soft Tissue vs. Bone Malignancies Based on Anatomic Location in the Inpatient Setting.

Surgical excisions of upper and lower extremity malignancies are increasing annually, due in part to the rising incidence of sarcomas. The purpose of this study is to compare readmissions, reoperation rate, and complications following surgical excision of soft/connective tissue vs bone malignancies of the upper and lower extremities. The Nationwide Readmissions Database (NRD) was queried from 2016-2017 to conduct a retrospective analysis of 16,435 patients diagnosed with malignant neoplasms of the long bone (ULLB, n = 1,433) and soft tissue (ULST, n = 2,049) of the upper limb and malignant neoplasms of the long bone (LLLB, n = 5,422) and soft tissue (LLST, n = 7,531) of the lower limb. Patients who underwent surgical excision of their neoplasms were included. Binomial multivariate logistic regression was used to compare complications, nonelective readmission rates, and reoperation rates between the two groups at 30 and 90 days. Average age of the ULST group was 61.88, with 36% female. Average age of the ULLB group was 44.97, with 41.90% female. Average age of the LLST group was 60.96, with 46.90% female. Average age of the LLLB group was 43.09, with 42.60% female. The ULST group had lower odds of readmission within 30 days (p=0.263), which became significant within 90 days of surgery (p=0.045). The LLST group had significantly higher odds of infection, reoperation within 30 to 90 days of the index surgery compared to the LLLB group (p < 0.0001). The LLST group had significantly lower odds of readmission within 30 (p=0.04) and 90 days (p=0.015) of the index surgery. Patients in the ULST group had significantly lower odds of 90-day readmission compared to the ULLB group. There were also significantly lower odds of 30- and 90-day readmission in the LLST group compared to the LLLB group. However, the LLST group had significantly higher odds of infection and reoperation within 30 and 90 days compared to the LLLB group.

P494: MYELOID LEUKEMIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A RETROSPECTIVE COHORT STUDY

Background: Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease and affect around 3.1 million adults in the United States (US). The data on the risk of myeloid leukemia among patients with IBD are limited and there has been only a couple of studies that evaluated the incidence of myeloid leukemia in this patient population. Aims: This study aimed to estimate the prevalence of myeloid leukemia in patients with IBD. Secondary outcomes included mortality, length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Methods: This is a retrospective cohort study for patients with IBD in the US. We queried the Nationwide Readmission Databases 2016-2018 using ICD-10-CM codes to identify all adult patients admitted for IBD. Patients with a comorbid diagnosis of myeloid leukemia including acute myeloid leukemia (AML), chronic myeloid leukemia (CML), Myeloid sarcoma, and Unspecified Myeloid leukemia were identified. Figure 1 summarizes the case selection process. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. Multivariate regression analysis was performed to study the impact of comorbid myeloid leukemia on inpatient mortality and non-elective readmissions. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA). Results: We extracted 365,152 index hospitalization records for IBD, 1052 (0.3%) had myeloid leukemia. Six hundred sixteen patients had acute myeloid leukemia (AML), 341 patients had chronic myeloid leukemia, 10 patients had myeloid sarcoma and 104 had unspecified myeloid leukemia. IBD patients with myeloid leukemia were older (64; Interquartile Range (IQR): 52-73 vs. 56; IQR: 38-70, P <0.001), more common to be males (50.8% vs. 49.2%, P <0.001) compared to IBD patients without myeloid leukemia. Having myeloid leukemia was associated with increased length of stays in days (7; Interquartile Range (IQR): 3-23 vs. 3; IQR: 2-6, P <0.001), increased median total charges ($74,413; IQR: $31,700 - $259,676 vs. $32,586; IQR: $17,827 - $62,260, P <0.001). On multivariate analysis; having myeloid leukemia was associated with increased mortality (Odds ratio (OR): 6.544; 95% confidence interval (CI): 5.318-8.052, P <0.001) and higher odds of all-cause 30-day non-elective readmission (OR: 1.4; 95% CI: 1.155-1.697, P= 0.001). Image:Summary/Conclusion: In our nationwide cohort of IBD patients, 0.3% had myeloid leukemia. Given the associated mortality and morbidity, we recommend considering a hematological consult for IBD patients with leukocytosis or leukopenia for further evaluation and appropriate management. More research studies are needed to investigate the pathogenesis of myeloid leukemia in IBD patients.

Iron Deficiency Anemia: An Overlooked Complication of Crohn's Disease.

BackgroundThere are few studies to evaluate the association between iron deficiency anemia (IDA) and Crohn’s disease (CD). We examined this association in a USA-based cohort of patients with CD.MethodsWe queried the Nationwide Readmission Databases 2018 using the International Classification of Disease, 10th Revision, and Clinical Modification (ICD-10-CM) codes to identify all adult patients admitted with a diagnosis of CD. Primary outcomes were the prevalence of IDA among patients with CD. Secondary outcomes included inpatient mortality, the length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Multivariate regression analysis was performed to study the impact of IDA on inpatient mortality and non-elective readmissions.ResultsOf the 72,076 patients discharged from an index hospitalization for CD, 8.1% had IDA. CD patients with IDA had increased length of stays in days (4, interquartile range (IQR): 2 - 6 vs. 3, IQR: 2 - 5; P < 0.001), increased median total charges ($35,160, IQR: $19,786 - $64,126 vs. $31,299, IQR: $17,226 - $59,561; P < 0.001), and were more common to require blood transfusion during hospitalization (13.6% vs. 3.4%, P < 0.001) compared to CD patients without IDA, respectively. IDA was independently associated with increased odds of all-cause 30-day non-elective readmission (odds ratio (OR): 1.254, 95% confidence interval (CI): 1.154 - 1.363, P < 0.001) and increased odds of all-cause 90-day non-elective readmission (OR: 1.396, 95% CI: 1.302 - 1.498, P < 0.001).ConclusionsIn a large nationwide cohort of patients hospitalized for CD, we observed a significant burden of IDA. Additionally, we found a significant association between IDA and worse hospitalization outcomes.

Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion.

This was a retrospective cohort study. The aim of this study was to compare the hospital charges and postoperative complications of minimally invasive surgery (MIS) and open approaches to sacroiliac joint (SIJ) fusion. The data source utilized in this study is the Healthcare Cost and Utilization Project National Readmission Database (NRD) from 2016 and 2017. The NRD is a yearly nationally representative inpatient database from the Agency for Healthcare Research and Quality with information regarding patient demographics, diagnoses, procedures, and readmissions. The 2016-2017 NRD was used to identify 2521 patients receiving SIJ fusion with open (n=1990) or MIS approaches (n=531) for diagnosed sacrum pain, sacroiliitis, sacral instability, or spondylosis after excluding for those who received prior SIJ fusion, those diagnosed with neoplasms or trauma of the pelvis or sacrum, and nonelective procedures. We then one-to-one propensity-matched the open (n=531) to the MIS approach (n=531) for age, sex, and Charlson Comorbidity Index. Statistical analysis was performed to compare total hospital charges, immediate surgical complications, nonelective readmission rate, and 30-, 90-, and 180-day postoperative complications between the 2 approaches. The mean total hospital charge was the only significant difference between 2 group. Open SIJ fusion had significantly higher charge compared with the MIS approach (open $101,061.90±$81,136.67; MIS $83,594.78±$49,086.00, P<0.0001). The open approach was associated with nonsignificant higher rates of novel lumbar pathology at 30-, 90-, and 180-day readmissions and revision surgeries at 30 and 180 days. MIS approach had higher rates nervous system complications at 30-, 90-, and 180-day readmission, as well as infection and urinary tract infection within 30 days, none being significant. Novel postprocedural pain was similar between the 2 groups at 90 and 180 days. The current study found that open SIJ fusion was associated with significantly higher hospital charges. Although no significant differences in postoperative complications were found, there were several notable trends specific to each surgical approach.

The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions.

Retrospective cohort study. The impact of modifiable risk factors (MRFs) on complications, costs, and readmission rates at 30, 90, and 180-days following lumbar spine fusion. Patients with lumbar spine fusions within the 2016-2017 Nationwide Readmissions Database (NRD). Patients were stratified by the following MRFs: Alcohol use, tobacco/nicotine use, nutritional malnourishment, dyslipidemia, and primary hypertension. Differences in complications, non-elective readmission rates, costs, and length of stay were compared between MRFs and the non-MRF group. Statistical analysis was conducted using Tukey multiple comparisons of means, 1-way ANOVA, Wald testing, unpaired Welch 2-sample t-tests, multivariate analysis, and predictive modeling. The final analysis included 297,579 lumbar fusion patients. At 30 and 90 days, patients with nutritional malnutrition, dyslipidemia, and primary hypertension had significantly greater readmission rates than patients without MRFs (all P<0.01). At 180-days, all MRFs had significantly greater readmission rates than the non-MRF group (all P<0.001). Dyslipidemia demonstrated significantly greater rates of myocardial infarction at 90 days compared to all groups (all P<0.02). Nutritional malnutrition was associated with a significantly greater mortality rate than primary hypertension, non-MRF, and tobacco/nicotine use at 90 days (P<0.001) and only tobacco/nicotine use at 180 days (P=0.007). Predictive modeling showed increases of 0.77%, 1.70%, and 2.44% risk of readmission at 30, 90, and 180-days respectively per additional MRF (all P<0.001). These findings highlight the negative impact each MRF has on patients following lumbar spinal fusion. Further longitudinal research is necessary to comprehensively characterize the effects of various MRFs on spine surgery outcomes.

S0805 Predictors of 30-Day Readmission in Ulcerative Colitis: A Nationwide Analysis

INTRODUCTION: Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory bowel diseases (IBD), with frequent hospital admission. Biologics have become the mainstay of therapy in patients with moderate and severe UC. Due to lack of contemporary readmission data since the advent of biologics, we decided to conduct a nationwide readmission study (NRD) on national United States (US) data, to identify the risk factors for 30-day readmission in UC patients after an index admission. METHODS: In this retrospective cohort study, we utilized Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Nationwide Readmission Database (NRD) for the year 2016 and 2017. In United States, NRD is the largest publicly available all-payer inpatient health care readmission database. We used the ICD10-CM diagnosis code K51.x to identify all adult patients with UC. RESULTS: There were 71,500,000 hospitalizations in 2016-2017 in the United States, 54,138 index admissions had UC as the primary diagnosis whereas 93,192 admission had UC as secondary diagnosis (Figure 1). The 30-day non-elective readmission rate after an index admission with a primary UC diagnosis was 13.2%. We used multivariate logistic regression to identify independent predictors of 30-day readmission. Age< 65, men, longer LOS, higher APR-DRG severity, pulmonary embolism, malnourished, electrolyte imbalance, anemic, anxious, alcohol use and bowel surgery. The variables that were associated with lower odds of 30-day readmission were older age, lower endoscopy, and marijuana use (Table 1). The rest of the variables had no influence on 30-day readmission. CONCLUSION: Our study identified the predictors of 30-day readmission associated with UC in the United States. This calls for a greater recognition of these risk factors and amelioration of its risk-factors, to prevent readmission and decrease mortality, whenever possible.Figure 1.: Flowsheet of the cohort of study population. Unweighted number of patients (weighted number). UC, Ulcerative colitis.Table 1.: Multivariate logistic regression analysis to identify independent risk factors for 30-day readmission in patients with Ulcerative ColitisTable 2.: Multivariate logistic regression analysis to identify independent risk factors for 30-day readmission in patients with Ulcerative Colitis

179. Propensity-matched analysis of 1,062 patients following minimally invasive versus open sacroiliac joint fusion

BACKGROUND CONTEXT The sacroiliac joint (SIJ) has been identified as a primary pain generator in a considerate proportion of low back pain (LBP) patients. Many patients turn to SIJ fusion after failure of conservative care to relieve SIJ pain. There are two surgical options for fusing the SIJ; an open or minimally invasive (MIS) approach. The open approach typically results in higher rates of postoperative complications and less improvement in patient reported pain and disability scores. PURPOSE The purpose of this study was to analyze the associated costs and postoperative complications of MIS and open approaches to SIJ fusion. STUDY DESIGN/SETTING Propensity-matched retrospective cohort study using the 2016-2017 National Readmission Database. PATIENT SAMPLE After excluding for all patients who had a prior SIJ fusion, those diagnosed with prior neoplasms or trauma of the pelvis and/or sacrum, and individuals whose primary SIJ fusion was nonelective, we identified 2,521 patients who received a SIJ fusion with an open (n=1,990) or MIS approach (n=531) for diagnosed sacrum pain, sacroiliitis, sacral instability or spondylosis. We then one-to-one propensity-matched the open (n=531) to the MIS approach (n=531) for age, sex and Charlson Comorbidity Index (CCI). OUTCOME MEASURES Costs, surgical outcomes, non-elective readmission rate, 30-, 90- and 180-day postoperative complications. METHODS We collected all of the individuals that had a non-elective readmission, separated them by surgical approach, and analyzed associated costs, surgical outcomes, non-elective readmission rate, 30-, 90- and 180-day postoperative complications. Statistical analysis was conducted in RStudio, with Welch two sample t-tests to compare complications and costs by surgical approach. RESULTS The mean cost of open SIJ fusion and was significantly higher compared to the MIS group (open $101,061.90 ±$81,136.67; MIS $83,594.78 ± $49,086.00, p CONCLUSIONS The current study found that MIS SIJ fusion was significantly less expensive than open SIJ fusion and was associated with less costly readmissions. Although no significant differences in postoperative outcomes were found, there were several notable trends specific to each surgical approach. Further investigation is required to fully characterize the potential advantages and disadvantages of the two surgical approaches. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Increased 30-day readmission rate after craniotomy for tumor resection at safety net hospitals in small metropolitan areas.

Unplanned readmission of post-operative brain tumor patients is often attributed to hospital and patient characteristics and is associated with higher mortality and cost. Previous studies demonstrate multiple patient outcome disparities in safety net hospitals (SNHs) when compared to non-SNHs. This study uses the Nationwide Readmissions Database (NRD) to determine if initial brain tumor resection at SNHs is associated with increased 30-day non-elective readmission rates. Patients with benign or malignant primary or metastatic brain tumor undergoing craniotomy for surgical resection were retrospectively identified in the NRD from 2010 to 2014. SNHs were defined as hospitals with Medicaid and uninsured patient burden in the top quartile. Descriptive and multivariate analyses employing survey-adjusted logistic regression evaluated patient and hospital level factors influencing 30-day readmissions. During the study period, 83,367 patients met inclusion criteria. 44.7% of patients had a benign tumor, and 55.3% had a malignant tumor. Secondary CNS neoplasm (5.99%), post-operative infection (5.96%), and septicemia (4.26%) caused most readmissions within 30days. Patients had increased unplanned readmission rates if they underwent craniotomy for tumor resection at a SNH in a small metropolitan area (OR 1.11, 95% CI 1.02-1.21, p = 0.01), but not at a SNH in a large metropolitan area (OR 0.99, 95% CI 0.93-1.05, p = 0.73). This finding may reflect differences in access to care and disparities in neurosurgical resources between small and large metropolitan areas. Inequities in expertise and capacity are relevant as surgical volume was also related to readmission rates. Further studies may be warranted to address such disparities.

62 Impact of the Affordable Care Act on Post-discharge Services After Burn Injury

Abstract Introduction Recovery from burn injury is a prolonged process often requiring post-discharge services such as rehabilitation or skilled nursing care. Affordable Care Act Open Enrollment (ACA-OE) began in January 2014 providing access to medical insurance for millions of previously uninsured Americans. Whether improved insurance coverage has improved access to post-discharge care for patients admitted with burn injury is unknown. We hypothesized that the ACA would improve insurance coverage for patients admitted with burn injury and that medical insurance would be associated with increased access to post-discharge care services. Methods The Nationwide Readmission Database was queried to identify patients ages 18–65 with an index admission for cutaneous burn injury using ICD-9 &amp; ICD-10 codes. Patients with Medicare or those that died during the index admission were excluded. Pre-ACA-OE admissions (2013, Q1-Q3) were compared with post-ACA admissions (2016, Q1-Q3) to evaluate the effects the ACA-OE of insurance status, length of stay, discharge disposition, 30- and 90-day readmission rates. Results There were 12,932 burn-injured patients included with 5,389 patients in 2013 and 7,543 patients in 2016. Post-ACA, Medicaid insurance increased from 33.0% to 43.9% (p&amp;lt; 0.001) while self-pay decreased from 25.8% to 13.7% (p&amp;lt; 0.001). Private insurance status did not change after implementation of the ACA (41.2% vs. 42.4%). Post-ACA-OE, overall routine discharge home decreased from 79.4% to 77.7% (p=0.02) while discharge to a care facility increased from 7.2% to 8.7% (p=0.002). Length of stay was not different between groups (8.9 ± 15.9 days vs. 9.0 ± 15.5 days). Medicaid patients had the highest readmission rates at 30- and 90-days (see Figure). Medicaid patients had decreased 90-day non-elective readmission rates post-ACA-OE (22.4% to 20.0%, p=0.041). Predictors of non-elective 90-day readmission were Medicaid insurance (OR 2.06, CI 1.76–2.40, p&amp;lt; 0.001) and older age (OR 1.03, CI 1.02–1.03, p&amp;lt; 0.001). Conclusions The ACA-OE increased access to insurance for burn patients. Discharges to care facilities after burn injury increased post-ACA-OE and was associated with decreased 90-day readmission. Ongoing advocacy efforts are need to improve access to post-burn care resources to optimize recovery from injury. Applicability of Research to Practice Awareness of the impacts of health policy and insurance coverage on access to post-discharge resources and readmission rates after burn injury.

Acute readmission following deep brain stimulation surgery for Parkinson's disease: A nationwide analysis

IntroductionDeep brain stimulation (DBS) surgery is an efficacious, underutilized treatment for Parkinson's disease (PD). Studies of DBS post-operative outcomes are often restricted to data from a single center and consider DBS in isolation. National estimates of DBS readmission and post-operative outcomes are needed, as are comparisons to commonly performed surgeries. MethodsThis study used datasets from the 2013 and 2014 Nationwide Readmissions Database (NRD). Our sample was restricted to PD patients discharged alive after hospitalization for DBS surgery. Descriptive analyses examined patient, clinical, hospital and index hospitalization characteristics. The all-cause, non-elective 30-day readmission rate after DBS was calculated, and logistic regression models were built to examine factors associated with readmission. Readmission rates for the most common surgical procedures were calculated and compared to DBS. ResultsThere were 6058 DBS surgeries for PD in our sample, most often involving a male aged 65 and older, who lived in a high socioeconomic status zip code. DBS patients had an average of four comorbidities. With respect to outcomes, the majority of patients were discharged home (95.3%). Non-elective readmission was rare (4.9%), and was associated with socioeconomic status, comorbidity burden, and teaching hospital status. Much higher acute, non-elective readmission rates were observed for common procedures such as upper gastrointestinal endoscopy (16.2%), colonoscopy (14.0%), and cardiac defibrillator and pacemaker procedures (11.1%). ConclusionShort-term hospitalization outcomes after DBS are generally favorable. Socioeconomic disparities in DBS use persist. Additional efforts may be needed to improve provider referrals for and patient access to DBS.

Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors.

Determine the rate, diagnoses, and risk factors associated with 30-day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer. Retrospective cohort study. We analyzed the Nationwide Readmissions Database for patients who underwent oropharyngeal cancer surgery between 2010 and 2014. Rates and causes of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission. Among 16,902 identified cases, the 30-day, nonelective readmission rate was 10.2%, with an average cost per readmission of $14,170. The most common readmission diagnoses were postoperative bleeding (14.1%) and wound complications (12.6%) (surgical site infection [8.6%], dehiscence [2.3%], and fistula [1.7%]). On multivariate regression, significant risk factors for readmission were major ablative surgery (which included total glossectomy, pharyngectomy, and mandibulectomy) (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.06-1.60), advanced Charlson/Deyo comorbidity (OR: 2.00, 95% CI: 1.43-2.79), history of radiation (OR: 1.58, 95% CI: 1.15-2.17), Medicare (OR: 1.34, 95% CI: 1.06-1.69) or Medicaid (OR: 1.82, 95% CI: 1.32-2.50) payer status, index admission from the emergency department (OR: 1.19, 95% CI: 1.02-1.40), and length of stay ≥6 days (OR: 1.57, 95% CI: 1.19-2.08). In this large database analysis, we found that approximately one in 10 patients undergoing surgery for oropharyngeal cancer is readmitted within 30 days. Procedural complexity, insurance status, and advanced comorbidity are independent risk factors, whereas postoperative bleeding and wound complications are the most common reasons for readmission. 4. Laryngoscope, 129:910-918, 2019.

Readmissions After Mechanical Thrombectomy for Acute Ischemic Stroke in the United States: A Nationwide Analysis

ObjectiveMechanical thrombectomy after acute ischemic stroke has been shown to improve clinical outcomes. Data on short-term hospitalization outcomes after thrombectomy are needed. Our objective was to quantify 30- and 90-day readmissions after thrombectomy and identify factors associated with readmissions. MethodsRetrospective observational analysis of adult patients hospitalized between January and November 2014, using data from the 2014 Nationwide Readmissions Database. Readmission rates were calculated and examined according to patient, clinical, and hospital characteristics using descriptive statistics. Weighted unconditional logistic regression models estimated the odds of readmission and examine the associations between select characteristics and readmission. Results4850 individuals who underwent mechanical thrombectomy for acute ischemic stroke in 2014 were eligible for 30-day readmissions analyses. The nonelective readmission rate was 12.5% at 30 days, 20.7% at 90 days. Sepsis and stroke were the most common reasons for readmission. Female sex (adjusted odds ratio [AOR] 1.34, 1.02-1.77 at 30 days), discharge to inpatient postacute care facility (AOR 1.61, 1.07-2.41 at 30 days, AOR 1.99, 1.47-2.69 at 90 days), and longer initial length of stay (AOR 1.52, 1.04-2.23 at 30 days, AOR 1.67, 1.14-2.43 at 90 days) were associated with a higher likelihood of readmission. Thrombectomy complications were rare and not associated with readmission. Conclusions1 in 8 thrombectomy patients had a short-term readmission in 2014. Characteristics suggestive of a complicated hospital course or greater physical disability were the primary predictors of readmission. This study provides preliminary data for evaluations of the public health impact of mechanical thrombectomy in real world settings.

Preoperative Bariatric Surgery and the Risk of Readmission Following Total Joint Replacement.

The purpose of this study was to compare nonelective and all-cause readmission rates and to identify risk factors for readmission of total joint arthroplasty (TJA) patients who had preoperative bariatric surgery (BS) compared with TJA patients without preoperative BS. The New York Statewide Planning and Research Cooperative System database was queried to identify 343,710 TJA patients between 2005 and 2014. Three patient groups were evaluated: group 1 (patients with preoperative BS within 2 years of TJA [N=1478]); group 2 (obese patients without preoperative BS [N=60,259]); and group 3 (nonobese patients without preoperative BS [N=281,973]). Nonelective and all-cause readmission rates (30 days, 90 days, and 1 year) were compared, and multivariate analyses of readmission risk factors were performed. Group 1 had no significant difference in nonelective readmission rates compared with groups 2 and 3. However, when elective TJA readmissions were included, group 1 had significantly higher all-cause readmission rates at 30 days, 90 days, and 1 year compared with groups 2 and 3. Bariatric surgery was not a risk factor for nonelective readmissions at any time point. When elective TJA admissions were included, BS was an independent risk factor for all-cause readmission at all time points. Patients who have BS prior to TJA do not have higher nonelective readmission rates than obese TJA patients without BS. Bariatric surgery is not a risk factor for nonelective readmissions. However, BS is a significant predictor of elective TJA admissions up to 1 year following the index TJA. [Orthopedics. 2018; 41(2):107-114.].

Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study.

Limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for peripheral arterial disease. However, the overall burden of readmissions has not been comprehensively explored. To evaluate nationwide readmissions after peripheral arterial revascularization for peripheral arterial disease and to assess whether readmission risk varies among hospitals. Retrospective cohort study. 1085 U.S. acute care hospitals participating in the Nationwide Readmissions Database. 61969 unweighted hospitalizations of patients with peripheral arterial disease who had peripheral arterial revascularization and were discharged alive between 1 January and 30 November 2014. 30-day readmission rates, causes, and costs of unplanned rehospitalizations after peripheral arterial revascularization; 30-day risk-standardized readmission rates (RSRRs), calculated using hierarchical logistic regression, to assess for heterogeneity of readmission risk between hospitals. Among 61969 hospitalizations of patients with peripheral arterial disease who were discharged alive after peripheral arterial revascularization, the 30-day nonelective readmission rate was 17.6%. The most common cause of readmission was procedural complications (28.0%), followed by sepsis (8.3%) and complications due to diabetes mellitus (7.5%). Among rehospitalized patients, 21.0% underwent a subsequent peripheral arterial revascularization or lower extremity amputation, 4.6% died, and the median cost of a readmission was $11013. Thirty-day RSRRs varied from 10.0% to 27.3% (interquartile range, 16.6% to 18.8%). Inability to distinguish out-of-hospital deaths after discharge and potential misclassification bias due to use of billing codes to ascertain diagnoses and interventions. More than 1 in 6 patients with peripheral arterial disease who undergo peripheral arterial revascularization have unplanned readmission within 30 days, with high associated mortality risks and costs. Procedure- and patient-related factors were the primary reasons for readmission. Readmission rates varied moderately between institutions after hospital case mix was accounted for, suggesting that differences in hospital quality may only partially account for readmission. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.

Abstract WMP94: Readmission Within 30 days After Acute Ischemic Stroke, United States 2013

Introduction: Hospital readmissions contribute significantly to the cost of medical care and reflect the burden of disease. Limited data have been reported on national hospital readmission after acute ischemic stroke. Methods: Among 2013 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD), we identified acute ischemic stroke (AIS) hospitalizations using principal diagnosis ICD-9-CM codes. We provided national estimates of AIS non-elective readmission rates within 30 days. Results: In 2013, there were a total of 489,813 adult index AIS admissions in the United States. The readmission rate within 30 days for a new AIS as the principal diagnosis was 2.1% of index AIS admissions, and was 10.2% of all readmissions. The readmission rate for all non-elective reasons increased with age, with the lowest readmission rate (8.9%) among ages 18-44, and the highest (11.7%).among ages 85+. The readmission rate was higher among patients with public insurance (11.1%) as compared to private (7.4%) or others (7.9%). Recurrent AIS (20.2%) was the most common reason for readmission, including unspecified cerebral artery occlusion with infarction (ICD9-CM=434.91, 13.0%) and cerebral embolism with infarction (ICD9-CM=434.11, 3.1%). In addition, infections were among the most common causes (Septicemia 5.7%, UTI 2.7%, and pneumonia 2.2%) and TIA (2.4%). Conclusions: The findings have important implications for identifying groups and conditions at high-risk for readmission. The large number of recurrent AIS within 30 days of index AIS highlights the need for improved patient follow-up and secondary prevention treatment.

Similar outcomes among general medicine patients discharged on weekends.

Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge. To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge. Retrospective cohort. All teaching hospitals in Alberta, Canada. General internal medicine (GIM) discharges (only 1 per patient). Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index. Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35-5.93 vs 7.86 days, 95% CI: 7.71-8.00, adjusted P value < 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long-term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77-1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85-1.41]). GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays.