Reasons For 30-day Readmission Research Articles

Rates and reasons for 30-day readmission after pancreatoduodenectomy for malignancy

Rates and reasons for 30-day readmission after pancreatoduodenectomy for malignancy

Sex differences in readmission rate after cardiac surgery.

The impact of sex on hospital readmission rate after cardiac surgery is unclear. Therefore, we aimed to analyse sex-specific differences and underlying factors in 30-day readmission rate after cardiac surgery. We conducted a single center study including all patients after major cardiac surgery (excluding aortic dissection and left ventricular assist device implantation) from January 2012 to September 2020. Reasons for readmission were adjudicated according to all available medical records. We calculated incidence rate ratios (IRR) with 95% confidence intervals (CI) for female sex with re-admission crude and adjusted for plausible confounding factors using negative binomial regression. 4,868 patients were included in the analysis. The median [Interquartile range] age was 68 [60 to 74] years and 24% (n = 1,149) of the patients were female. Female patients were significantly older (median [IQR] age 70 (63 to 76) vs. 67 (59 to 74), p < 0.001) and had lower body mass index and fewer cardiovascular risk factors compared to men. Isolated valve surgery was more frequent in female while coronary artery bypass grafting was more often in men. 30-day readmission was comparable between both sexes (7.0% [n = 81] in female vs. 8.7% [n = 322] in men; p = 0.078). Cardiac related readmissions and infections were the most common reasons for readmission in both groups. The overall incidence rate ratios of female sex with readmission (0.80, 95% CI 0.63 to 1.03, p = 0.078) remained robust after adjustment for EuroSCORE 2 (0.78, CI 0.61 to 1.0, p = 0.051). Readmission rate and reasons for 30-day readmission after major cardiac surgery were similar between men and women.

Rates and Reasons for 30-day Readmission after Pancreatoduodenectomy for Malignancy

Rates and Reasons for 30-day Readmission after Pancreatoduodenectomy for Malignancy

Incidence, Risk Factors, and Reasons for 30-Day Hospital Readmission Among Healthy Late Preterm Infants.

Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission. This is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model. Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had <5 days length of stay at birth. The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.

30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study

ObjectivesAnalysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data.MethodsA retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days.Results30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission.ConclusionThe 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.

The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis.

ObjectiveThe 30‐day readmission is associated with increased medical costs, which has become an important quality metric in several medical institutions. This current study is aimed at clarifying the prevalence, the underlying risk factors, and reasons of the 30‐day readmission after acute myocardial infarction (AMI).MethodsPubMed, Cochrane Library, and EMBASE were systematically searched to identify eligible studies. Random‐effect models were employed to perform pooled analyses. Means and 95% confidence intervals (CIs) were used to estimate prevalence and reasons for 30‐day readmission. We also used Odds ratios (ORs) to explore the potential significant predictors of risk factors of 30‐day readmission after AMI. Potential publication bias was assessed using funnel plot and Begg'test.ResultsA total of 14 relevant studies were included in this systematic review and meta‐analysis. The pooled 30‐day readmission rate of AMI was 12% (95% CI 0.11‐0.14). Acute coronary syndrome (ACS), angina and acute ischemic heart disease, and heart failure (HF) were the principal cardiovascular reasons of 30‐day readmission. Meanwhile, non‐specific chest pain was regarded as the significant cause among non‐cardiovascular reasons. The common co‐morbidities kidney disease, HF and diabetes mellitus were significant risk factors for 30‐day readmission. No significant publication bias was found by funnel plot and statistical tests.ConclusionsThe 30‐day readmission rate of post‐AMI ranged from 11% to 14% and can be mainly attributed to cardiovascular and non‐cardiovascular events. The common co‐morbidities, such as kidney disease, HF, and diabetes mellitus were significant risk factors for 30‐day readmission.

Abstract WP300: Complications After Intracerebral Hemorrhage and Intracranial Procedures: A Nationally Representative Estimate

Background: Intracranial procedures (including craniotomy/ craniectomy, external ventricular drain [EVD], ventriculoperitoneal shunt [VPS], stereotactic craniotomy, and administration of intraventricular alteplase [tPA]) are performed in severe cases of intracerebral hemorrhage (ICH). However, severity-adjusted national estimates of complications after such procedures are not known. Methods: The Nationwide Readmissions Database contains &gt;14 million discharges for all payers and uninsured in 2013. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify index cases of ICH, intracranial procedures, and comorbidities. We summarized demographics, comorbidities, and Charlson Comorbidity Index (CCI) during the index admission. Preventable causes of admission were determined by Prevention Quality Indicators. Multivariable Poisson regression models estimated associations between intracranial procedures and readmission rates up to 1 year. Model 1 adjusted for age, discharge status, and CCI; Model 2 adjusted for All Patients Refined Diagnosis Related Groups severity measures. Results: Among 26,160 index admissions for ICH with intracranial procedures, mean age (SD) was 68.6 (14.9) years; 48% were female; 28% diabetic; 70% hypertensive; 23% smokers, mean CCI (SD) was 3.5 (2.2). 25% were discharged home; 24% died during index admission; 30.7% had readmission during follow-up, 13.2% of which were preventable. Top reasons for 30-day readmission were acute cerebrovascular disease (21%), septicemia (8%), and renal failure (4%). In unadjusted models, craniotomy, EVD, and VPS were associated with higher readmission rates. In adjusted models, higher readmission rates were seen only after craniotomy (Model 1 rate ratio [RR] 1.13, 95% CI 1.08-1.19; Model 2 RR 1.10, 1.04-1.15). tPA and stereotactic craniotomy showed no significant associations. Conclusions: This analysis of nationally representative US data of ICH admissions showed a 10-13% increased rate of readmissions after craniotomy, most of which were non-preventable. Further research would clarify causal relationships and suggest ways to reduce readmission risk after this potentially life-saving procedure for ICH.

Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.

Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission. We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata. Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p<0.001). The proportion of asthma as the readmission diagnosis differed significantly by sex (6% in men and 9% in women; p<0.001). Similarly, the proportion of asthma also differed significantly by race/ethnicity (5% in non-Hispanic white, 16% in non-Hispanic black, 15% in Hispanics, 13% in others; p<0.001). In this analysis of all-payer population-based data, we found sex and racial/ethnic differences in the reason for 30-day readmission in patients hospitalized for COPD.