Odds Of All-cause Readmission Research Articles

Abstract 4134267: Effects of GLP-1 Receptor Agonists and SGLT2 Inhibitors on In-Hospital Mortality and 30-Day Readmission in Type 2 Diabetic Patients with Acute Coronary Syndrome

Background: The effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 inhibitors (SGLT2is) on reducing cardiovascular events in heart failure patients are well-established; however, less is known about their effects after a myocardial infarction. This study aims to investigate the effects of GLP-1RAs and SGLT2is on in-hospital mortality and 30-day readmission in type 2 diabetic patients with/without heart failure who were hospitalized for acute coronary syndrome (ACS). Methods: We conducted a multicenter retrospective cohort on type 2 diabetic patients who were admitted to the hospital for ACS from 01/01/2020 to 01/31/2024 across 16 West Florida hospitals. Patients receiving a GLP-1RA alone, SGLT2i alone, or both were compared to those taking neither. Chi-square and binary logistic regression were used to predict the clinical outcomes of in-hospital mortality, all-cause readmission within 30 days, and cardiac readmission within 30 days. Results: Among 7,481 type 2 diabetics with ACS, 392 (5.24%) were taking GLP-1RA monotherapy, 577 (7.71%) were taking SGLT2i monotherapy, 144 (1.92%) were taking both, and 6,362 (85.12%) were taking neither. The likelihood of in-hospital mortality was similar among patients on neither medication compared to patients on both (χ 2 = 0.06, p = 0.802), GLP-1RA monotherapy (χ 2 = 0.61, p = 0.435), and SGLT2i monotherapy (χ 2 = 0.002, p = 0.968). The odds of all-cause readmission within 30 days was similar among patients on neither medication compared to patients on both (χ 2 = 0.0004, p = 0.983), GLP-1RAs monotherapy (χ 2 = 0.07, p = 0.791), and SGLT2i monotherapy (χ 2 = 3.10, p = 0.078). The likelihood of cardiac readmission within 30 days was similar among patients on neither medication compared to patients on both medications (χ 2 = 1.63, p = 0.202), GLP-1RA monotherapy (χ 2 = 0.95, p = 0.329), and SGLT2i monotherapy (χ 2 = 0.94, p = 0.332). Conclusion: Our study found no significant differences in the odds of in-hospital mortality or 30-day readmission among type 2 diabetics with ACS who were taking GLP-1RAs, SGLT2is, or both, when compared to those taking neither. These findings further support the outcomes discovered in the EMPACT-MI trial.

Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants. To examine hospital readmissions for infants with and without NOWS. This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024. Neonatal opioid withdrawal syndrome. Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth. Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (>36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P < .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant. In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.

Comorbidities associated with 30-day readmission following index coronavirus disease 2019 (COVID-19) hospitalization: A retrospective cohort study of 331,136 patients in the United States.

Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission. We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital. Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17-1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09-1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58-2.19), renal failure (aOR, 1.32; 95% CI, 1.25-1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24-1.34) were most associated with readmission for COVID-19. Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.

Weight change in heart failure inpatients not associated with 30-day readmission.

Background: The association of weight change and short-term readmission in patients hospitalized for heart failure (HF) has not been well studied. Methods: We collected clinical and weight data from patients admitted with decompensated HF to a single center (2012-2013). We performed logistic regression to determine the association between weight change and two outcomes: a total of30-day HF-specific readmission and 30-day all-cause readmission. Results: Admission and discharge weights were documented in 479/658 patients (73%). Weight loss >2kg was not associated with 30-day all-cause or HF-specific readmission when compared with more modest inpatient weight change (-2kg to+2kg;all-cause readmission odds ratio: 0.86; CI: 0.56-1.37; HF-specific readmission odds ratio: 1.15; CI: 0.61-2.16). Conclusion: Among HF inpatients, in-hospital weight loss was not associated with 30-day all-cause or HF-specific readmission.

The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics

Objectives To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient...

Circulation: Heart Failure Editors’ Picks

Summary: Medicare’s introduction of public reporting and value-based purchasing centered on 30-day risk-adjusted readmission rates after hospital discharge for heart failure (HF) has helped to heighten interest among state governments and commercial payers in HF readmissions. As all potentially avoidable HF readmissions represent an opportunity to improve healthcare quality and efficiency, understanding the rates and predictors in non-Medicare populations is important. This is particularly true among patients with systolic dysfunction, for whom most HF-specific therapies are targeted. Using claims-based administrative data, we evaluated 1198 Medicaid and 3350 commercially insured unique systolic HF index admissions. All patients were <65 years of age, with a mean age of 55 years. Unadjusted all-cause 30-day readmission rates were 17.4% for Medicaid enrollees and 11.8% for commercially insured patients. After adjustment for differences in case mix, the odds of all-cause readmission were 32% higher among Medicaid than commercially insured patients, and 68% higher when only HF-related readmissions were considered. No significant differences in readmission rates were seen for managed care versus fee-for-service or capitated versus noncapitated plan types. These results suggest that socioeconomically disadvantaged populations, as indicated by Medicaid insurer status, represent a high-risk population potentially warranting specific interventions. Conclusions: Compared with commonly cited Medicare HF readmission rates of 20% to 25%, Medicaid patients with systolic HF had lower 30-day readmission rates, and commercially insured patients had even lower rates. Even after adjustment for case mix, Medicaid patients were more likely to be readmitted than commercially insured patients, suggesting that more attention should be focused on readmissions among socioeconomically disadvantaged populations.1 Summary: Hospital readmissions for heart failure (HF) contribute to increased morbidity and resource burden. However, the predictors of hospitalization and patterns of cardiovascular events during the lifetime of patients with HF have not been elucidated. In this study, the authors examined recurrent hospitalizations, …