Risk Factors For 30-day Readmission Research Articles

Bias in Prediction Models to Identify Patients With Colorectal Cancer at High Risk for Readmission After Resection

PURPOSE Machine learning (ML) algorithms are used for predictive modeling in medicine, but studies often do not evaluate or report on the potential biases of the models. Our purpose was to develop clinical prediction models for readmission after surgery in patients with colorectal cancer (CRC) and to examine their potential for racial bias. METHODS We used the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program Participant Use File and Targeted Colectomy File. Patients were categorized into four race groups—White, Black or African American, other, and unknown/not reported. Potential predictive features were identified from studies of risk factors of 30-day readmission in patients with CRC. We compared four ML-based methods—logistic regression, multilayer perceptron, random forest, and XGBoost (XGB). Model bias was assessed using false-negative rate (FNR) difference, false-positive rate (FPR) difference, and disparate impact (DI). RESULTS In all, 112,077 patients were included, 67.2% of whom were White, 9.2% Black, 5.6% other race, and 18% with race not recorded. There were significant differences in the area under the receiver operating characteristics curve, FPR, and FNR between race groups across all models. Notably, patients in the other race category had higher FNR compared with Black patients in all but the XGB model, while Black patients had higher FPR than White patients in some models. Patients in the other category consistently had the lowest FPR. Applying the 80% rule for DI, the models consistently met the threshold for unfairness for the other race category. CONCLUSION Predictive models for 30-day readmission after colorectal surgery may perform unequally for different race groups, potentially propagating to inequalities in delivery of care and patient outcomes if the predictions from these models are used to direct care.

Factors Associated with 30-Day Readmissions after Transsphenoidal Pituitary Surgery

PurposeDetermine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery. MethodsPatients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N=83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N=174). ResultsIn a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR=2.335, 95% CI 1.050, 5.562, p=0.045). The presence of AVP deficiency increased the odds of readmission by more than 2-fold (OR=2.784, 95% CI 1.118, 7.124, p=0.029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR=0.334, 95% CI 0.134, 0.813, p=0.016), with the Southeast site being comparable to the Southwest. ConclusionOur study identifies postoperative AVP deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.

Associations Between Readmission and Length of Stay in the Acute Admission Unit for Patients with Alcohol-Related Diagnoses-A Cohort Study.

Patients with alcohol-related diagnosis in emergency departments (ED) are at high risk of readmission. Evidence shows an association between alcohol related admissions and a wide range of diseases and disorders. Understanding the risk factors for readmission and the asso-ciation with length of stay in the ED may help identify those who would benefit from targeted interventions. Thus, the hypothesis of this study is that patients with alcohol-related diagnoses and a short length of stay in the ED have a higher risk for readmission. Therefore, this study aimed to investigate the association between length of stay in the ED and 30-day readmission for patients with alcohol-related acute admissions as well as to uncover possible risk factors for 30-day read-mission. The study used a retrospective cohort design and was carried out from March 1, 2019, to January 31, 2020. The inclusion criteria were ≥ 18 years, admitted to an ED, and having an alcohol-related primary or secondary diagnosis (based on ICD-10 codes). Patients were fol-lowed for 30 days after discharge from initial hospitalization to identify associations between length of stay and 30-day readmission. We included 1,174 patients and found that 17% (95% CI: 15-20) of the patients admitted with an alcohol-related primary or secondary diagnosis were readmitted within 30 days. The hazard ratio (HR) for readmission increased with length of stay when compared to admission ≤ 24 hr; admission > 24-48 hr HR 1.50 (95% CI: 1.08-2.08), admission > 48 hr HR 2.08 (95% CI: 1.23-3.52). The study revealed that patients with alcohol-related diagnoses were at a higher risk of ED readmission the longer they stayed in the ED. Furthermore, the risk of readmis-sion increased if patients had a medical or psychiatric diagnosis prior to admission or lived alone.

Risk Factors for 90-Day Readmission Among Patients with Metastatic Spine Tumors in South Korea: A Nationwide Population-Based Study

Population-based studies on the cause of readmission within 90 days after surgery or radiotherapy for metastatic spine tumors are scarce. We aimed to investigate the risk factors for readmission within 90 days after initial surgical or radiation treatment for metastatic spine tumors. Patients who were diagnosed with metastatic spine tumors between 2012 and 2019 and underwent spinal magnetic resonance imaging within 1 year were classified according to treatment (surgical or radiotherapy groups), and the causes of the 90-day readmission and patient characteristics were compared. Overall, data from 15,815 patients (surgical group, 13,974 patients; radiotherapy group, 1,841 patients) were evaluated. Radiotherapy was preferred in younger and male patients with a high Charlson Comorbidity Index (CCI), whereas surgery was mainly performed in patients with lumbar metastasis. Radiotherapy, age of 30-69 years, male sex, and CCI > 1 increased the risk of 90-day readmission in patients with metastatic spine tumors. The main causes of 90-day readmission among patients with metastatic spine tumors who received radiotherapy included tumor recurrence, chemotherapy, radiotherapy, and treatment of other organ metastases with radiotherapy. These study findings offer a better understanding of the causes of readmission following radiotherapy or surgical treatment in patients with metastatic spine tumors, and these results can help reduce postoperative morbidity and medical costs among these patients.

Readmissions Following Endovascular Thoracic and Thoracoabdominal Aortic Repairs in the Vascular Implant Surveillance and Interventional Outcomes Network (VISION)

ObjectivesInvestigate readmission rates, diagnoses associated with readmission, and associations with mortality through 90-days post-operatively after elective endovascular thoracic and thoracoabdominal aortic repair overall and by extent of coverage. MethodsA cohort of index elective non-traumatic endovascular thoracic and thoracoabdominal aortic cases from 2010-2018 was derived from the Vascular Implant Surveillance and Interventional Outcomes Network. Cohort readmissions within 90-days postoperative were examined both overall and by Crawford extent (CE) of aortic coverage. Postoperative mortality was examined by reason for readmission and CE. ResultsThe cohort consisted of 2,093 patients who underwent endovascular thoracic and thoracoabdominal aortic repair (1,541 CE 0A/0B; 240 CE 1-3; 312 CE 4-5). Cumulative risk for 90-day readmission was 34.3% in CE 0A/0B repairs, 33.4% in CE4-5 repairs and 47.4% in CE 1-3 repairs. Compared to CE 0A/B, patients with CE 1-3 repairs experienced an increased risk of readmission within 90 days postoperatively after adjusting for preoperative factors (aHR 1.27(1.00,1.61) while the readmission risk for CE 4-5 repairs did not differ significantly (aHR 0.83 (0.64,1.06). Significant risk factors for 90-day readmission included COPD, dialysis dependence, limited ambulation, visceral/spinal ischemia, and in-hospital stroke. Discharge to home was protective against readmission (HR 0.65, CI 0.54-0.79). Patients with a readmission within 90-days had a 7.89-fold increase in 90-day mortality (HR 7.84; 5.17, 11.9) compared to those not readmitted. ConclusionsIncreasing extent of endovascular thoracic and thoracoabdominal aortic repair was associated with higher 90-day readmission rates. Readmission for all CE was associated with near 8-fold increased risk of mortality. Risk factors associated with increased risk for readmission included pulmonary insufficiency, renal disease, and poor functional status. These findings can inform stakeholders about investment of resources to improve processes of care that both target prevention and mitigate risk of readmission after elective endovascular thoracic and thoracoabdominal aortic repair.

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis: A propensity-matched analysis.

Patients with acute pancreatitis (AP) frequently experience hospital readmissions, posing a significant burden to healthcare systems. Acute peripancreatic fluid collection (APFC) may negatively impact the clinical course of AP. It could worsen symptoms and potentially lead to additional complications. However, clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce. Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs. To evaluate the association between APFC and 30-day readmission in patients with AP. This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019. Patients with a primary diagnosis of AP were identified. Participants were categorized into those with and without APFC. A 1:1 propensity score matching for age, gender, and Elixhauser comorbidities was performed. The primary outcome was early readmission rates. Secondary outcomes included the incidence of inpatient complications and healthcare utilization. Unadjusted analyses used Mann-Whitney U and χ 2 tests, while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios (aHR). Kaplan-Meier curves and log-rank tests verified readmission risks. A total of 673059 patients with the principal diagnosis of AP were included. Of these, 5.1% had APFC on initial admission. After propensity score matching, each cohort consisted of 33914 patients. Those with APFC showed a higher incidence of inpatient complications, including septic shock (3.1% vs 1.3%, P < 0.001), portal venous thrombosis (4.4% vs 0.8%, P < 0.001), and mechanical ventilation (1.8% vs 0.9%, P < 0.001). The length of stay (LOS) was longer for APFC patients [4 (3-7) vs 3 (2-5) days, P < 0.001], as were hospital charges ($29451 vs $24418, P < 0.001). For 30-day readmissions, APFC patients had a higher rate (15.7% vs 6.5%, P < 0.001) and a longer median readmission LOS (4 vs 3 days, P < 0.001). The APFC group also had higher readmission charges ($28282 vs $22865, P < 0.001). The presence of APFC increased the risk of readmission twofold (aHR 2.52, 95% confidence interval: 2.40-2.65, P < 0.001). The independent risk factors for 30-day readmission included female gender, Elixhauser Comorbidity Index ≥ 3, chronic pulmonary diseases, chronic renal disease, protein-calorie malnutrition, substance use disorder, depression, portal and splenic venous thrombosis, and certain endoscopic procedures. Developing APFC during index hospitalization for AP is linked to higher readmission rates, more inpatient complications, longer LOS, and increased healthcare costs. Knowing predictors of readmission can help target high-risk patients, reducing healthcare burdens.

The correlation between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study.

This study aimed to investigate the association between admission hyperglycemia and 30-day readmission after hip fracture surgery in geriatric patients. This retrospective study included 1253 geriatric hip fracture patients. Patients were categorized into normoglycemia(<6.10 mmol/L) and hyperglycemia groups(≥6.10 mmol/L) based on admission blood glucose. We performed multivariable logistic regression analyses and propensity score matching (PSM) to estimate adjusted odds ratios and 95% confidence intervals for 30-day readmission, controlling for potential confounding factors. An analysis of the dose-dependent association between admission blood glucose and the probability of 30-day readmission was performed. Additional subgroup analysis was conducted to examine the impact of other factors on the relationship between admission blood glucose and 30-day readmission. Patients with hyperglycemia had higher 30-day readmission rates than normoglycemic patients before (19.1% vs 9.7%, p<0.001) and after PSM (18.1% vs 12.3%, p=0.035). Admission hyperglycemia was an independent predictor of increased 30-day readmission risk, with an adjusted odds ratio of 1.57 (95% CI 1.08-2.29, p=0.019) after multivariable regression and 1.57 (95% CI 1.03-2.39, p=0.036) after PSM. A dose-response relationship was observed between higher glucose levels and increased readmission risk. Admission hyperglycemia is an independent risk factor for 30-day readmission after hip fracture surgery in the elderly. Routine glucose testing upon admission and perioperative glycemic control may help reduce short-term readmissions in this vulnerable population.

Development and validation of a nomogram for 30-day readmission after hip fracture surgery in geriatric patients.

30-day readmission after hip fracture surgery in the elderly is common and costly. A predictive tool to identify high-risk patients could significantly improve outcomes. This study aims to develop and validate a risk nomogram for 30-day readmission after hip fracture surgery in geriatric patients. We retrospectively analyzed 1,249 geriatric hip fracture patients (≥60 years) undergoing surgery at Dandong Central Hospital from October 2011 to October 2023. Using a 7:3 ratio, patients were randomly divided into training (n=877) and validation (n=372) sets. Independent risk factors for 30-day readmission were identified using LASSO regression and logistic regression in the training set. A nomogram was constructed using the identified predictors. Finally, the C-index, ROC curve, calibration curve, and decision curve analysis were used to validate the model in the training and validation sets respectively. The nomogram was developed based on the 8 predictors of age, prior stroke, chronic liver disease, treatment, uric acid (UA), total protein (TP), albumin (ALB), and pneumonia that were found to be independently associated with 30-day readmission. The nomogram showed good discrimination with a C-index of 0.88 in the training set and 0.84 in the validation set. Calibration curves exhibited good agreement between predicted and observed outcomes. Decision curve analysis demonstrated clinical utility. We developed and validated a nomogram incorporating eight clinical variables to accurately predict the individualized risk of 30-day readmission after hip fracture surgery in elderly patients. The model demonstrated favorable discrimination, calibration, and clinical utility. It can help to identify high-risk patients needing additional interventions to prevent avoidable hospital readmissions.

Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis.

The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue. Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class (OR, 1.502; 95%CI:1.405-1.605; P < .001), heart failure (OR,1.494; 95%CI: 1.235-1.754; P < .001), diabetes (OR, 1.246; 95%CI:1.128-1.377; P < .001), liver disease (OR, 1.339; 95%CI:1.237-1.450; P < .001), drinking (OR, 1.114; 95%CI:1.041-1.192; P = .002), depression (OR, 1.294; 95%CI:1.223-1.396; P < .001), urinary tract infection (OR, 5.879; 95%CI: 5.119-6.753; P < .001), and deep vein thrombosis (OR, 10.007; 95%CI: 8.787-11.396; P < .001) showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk. The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.

30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

Risk factors for 30-day readmission following shoulder arthroscopy: a systematic review.

Recently, there has been a rapid shift from open shoulder surgery to arthroscopic shoulder procedures for treating several shoulder pathologies. This shift is mainly due to reduced postoperative complications and 30-day readmission. Although the 30-day readmission rate is low, the risk still exists. One way to minimize the risk factors is to analyze all the risk factors contributing to the 30-day readmission following shoulder arthroscopy. Electronic databases such as PubMed, Google Scholar, and Cochrane library were searched. Studies were selected based on predefined inclusion and exclusion criteria. Newcastle-Ottawa score was used for the quality assessment of individual studies. Two reviewers extracted data from the selected studies. Results were evaluated through narrative analysis and presented as an odds ratio with 95% confidence interval. A meta-analysis was not possible due to the heterogeneity in the available data. A total of 12 studies evaluating 494,038 patients were selected in our review. All the studies have a low risk of bias (median=8). Significant factors predicting readmission included age, gender, COPD (chronic obstructive pulmonary disorder), steroid use, smoking, preoperative opioid use, higher American Society of Anesthesiologists (ASA) score (3 or higher), and general and regional anesthesia vs. regional anesthesia alone. Through our systematic review, we tried to identify risk factors that can predict 30-day readmission following shoulder arthroscopy. These include age > 65 years, COPD, steroid use, opioid use, and OR time > 90 mins. These high-risk patients could be triaged earlier by identifying these parameters, and effective pre and post-operative surveillance could minimize 30-day readmission risk following shoulder arthroscopy.

Severe Obesity Is an Independent Risk Factor of Early Readmission and Nonhome Discharge After Cervical Disc Replacement.

Despite growing interest in cervical disc replacement (CDR) for conditions such as cervical radiculopathy, limited data exists describing the impact of obesity on early postoperative outcomes and complications. These data are especially important as nearly half of the adult population in the United States is expected to become obese (body mass index [BMI] ≥ 30 kg/m2) by 2030. The goal of this study was to compare the demographics, perioperative variables, and complication rates following CDR. The 2005-2020 American College of Surgeons National Surgical Quality Improvement Program datasets were queried for patients who underwent primary 1- or 2-level CDR. Patients were divided into 3 cohorts: Nonobese (BMI: 18.5-29.9 kg/m2), Obese class-I (BMI: 30-34.9 kg/m2), Obese class-II/III (BMI ≥ 35 kg/m2). Morbidity was defined as the presence of any complication within 30 days postoperatively. Rates of 30-day readmission, reoperation, morbidity, individual complications, length of stay, frequency of nonhome discharge disposition were collected. A total of 5,397 patients were included for analysis: 3,130 were nonobese, 1,348 were obese class I, and 919 were obese class II/III. There were more 2-level CDRs performed in the class II/III cohort compared to the nonobese group (25.7% vs. 21.5%, respectively; p < 0.05). Class-II/III had more nonhome discharges than class I and nonobese (2.1% vs. 0.5% vs. 0.7%, respectively; p < 0.001). Readmission rates differed as well (nonobese: 0.5%, class I: 1.1%, class II/III: 2.1%; p < 0.001) with pairwise significance between class II/II and nonobese. Class II/III obesity was an independent risk factor for both readmission (odds ratio [OR], 3.32; p = 0.002) and nonhome discharge (OR, 2.51; p = 0.02). Neither 30-day reoperation nor morbidity rates demonstrated significance. No mortalities were reported. Although obese class-II/III were risk factors for 30-day readmission and nonhome discharge, there was no significant difference in reoperation rates or morbidity. CDR procedures can continue to be safely preformed independent of obesity status.

Identifying risk factors for 30-day readmission after outpatient total shoulder arthroplasty to aid in patient selection

A recent meta-analysis comparing inpatient and outpatient total shoulder arthroplasty (TSA) showed no statistically significant differences in complications, readmissions, revisions, and infections. However, there remains no research on the appropriate patient selection for outpatient TSA surgeries. This retrospective review seeks to aid surgeons in refining a safe patient selection algorithm by evaluating risk factors through a large database analysis of TSA surgeries. Patients who underwent TSA between 2015 and 2020 were identified in the National Surgical Quality Improvement Program database. Patients with a hospital stay of 0 days were designated as outpatient procedures. Multivariate analyses were used to determine risk factors for 30-day readmission following outpatient TSA and whether risk factors remained significant following overnight hospital stay. A total of 2431 outpatient TSA patients were identified. The incidence of 30-day readmission was 1.8%. The majority of readmissions were due to pulmonary complications. The clinically significant risk factors for 30-day readmission were chronic steroid use (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.34-9.43; P=.011), chronic obstructive pulmonary disease (COPD) (OR 3.11, 95% CI 1.16-8.34; P=.024), and current smoking status (OR 2.27, 95% CI 1.02-5.03; P=.045). After overnight hospital stay, chronic steroid use and current smoking status were not significant, but COPD remained significant. Patients with chronic steroid use, COPD, or current smoking status are at increased risk for 30-day readmission. Inpatient hospital stay appears to benefit patients with chronic steroid use and current smoking status. Patients with COPD should be admitted for inpatient stay postoperatively but may still have high 30-day readmission rates following discharge.

The Path to Sustainable Healthcare: Implementing Care Transition Teams to Mitigate Hospital Readmissions and Improve Patient Outcomes.

Introduction Hospital readmissions within 30 days suggest care quality issues and increased mortality risks. They result from ineffective initial treatment, poor discharge planning, and inadequate post-acute care. These high readmission rates harm patient outcomes and financially strain healthcare institutions, inviting penalties and discouraging potential patients. Enhancing inpatient care, care transitions, and case management is crucial to lowering readmissions. Our research underscores the role of care transition teams in reducing readmissions and financial stress in hospitals. By consistently applying transition strategies and focusing on high-quality care, we can improve patient outcomes and ensure hospital success in the long run. Methods This two-phase study investigated readmission rates and risk factors in a community hospital from May 2017 to November 2022. Phase 1 determined a baseline readmission rate and identified individual risk factors using logistic regression. In phase 2, a care transition team addressed these factors by providing post-discharge patient support through phone calls and assessing social determinants of health (SDOH). Readmission data from the intervention period was compared to baseline data using statistical tests. Data, including demographics, medical conditions, and comorbidities, were collected via electronic medical records and the International Classification of Diseases (ICD-10 codes). The study focused on patients aged 20-80 with readmissions within 30 days. Exclusions were made to minimize confounding effects from unmeasured comorbidities and ensure an accurate representation of factors affecting readmissions. Results In the study's initial phase, 74,153 patients participated, with an 18% mean readmission rate. Women accounted for 46% of readmissions, and the white population had the highest rate (49%). The 40-59 age group showed a higher readmission rate than other age groups, and certain health factors were identified as risk factors for 30-day readmission. In the subsequent phase, a care transition team intervened with high-risk groups using an SDOH questionnaire. They contacted 432 patients, resulting in a reduced overall readmission rate of 9%. The 60-79 age group and the Hispanic population experienced higher readmission rates, and the previously identified health factors remained significant risk factors. Conclusion This study emphasizes the crucial role of care transition teams in reducing hospital readmission rates and easing the financial strain on healthcare institutions. By identifying and addressing individual risk factors, the care transition team effectively lowered the overall readmission rate from 18% to 9%. Continually implementing transition strategies and prioritizing high-quality care focused on minimizing readmissions are essential for improving patient outcomes and long-term hospital success. Healthcare providers should consider utilizing care transition teams and social determinants of health assessments to better understand and manage risk factors and tailor post-discharge support for patients at higher risk of readmission.

Risk Factors for Unexpected Hospital Admission Following Achilles Tendon Repair: A National Database Study

INTRODUCTION Achilles tendon rupture (ATR) repair is one of the most common orthopaedic surgeries performed in the United States, however there is a paucity of literature on predisposing risk factors for hospital readmissions. The purpose of this study is to identify risk factors for 30-day readmission in patients undergoing ATR repair with emphasis on procedures performed in the outpatient setting. Specifically, we examine: 1) 30-day post-operative hospital readmission rates; 2) the medical comorbidities and patient characteristics that predisposed this cohort to post-operative complications; and 3) the complications leading to readmission. METHODS The ACS-NSQIP was queried for patients who underwent ATR from 2015 to 2019 using CPT code 27650 in all fields yielding a sample size of 3,887 cases. The following demographic, lifestyle, and comorbidity variables were recorded: age, sex, race, BMI, morbid obesity (BMI ≥ 40.00 kg/m2), bleeding disorders, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, tobacco use, and chronic steroid use. The primary outcome of 30-day readmission was defined as unplanned hospital readmission likely related to the principal procedure. Independent samples Student’s t-tests, chi-squared, and, where appropriate, Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following ATR. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. RESULTS Of the 3,887 patients included in our sample, 28 were readmitted within the 30-day post-operative period, corresponding to a readmission rate of 0.73%. Significant relationships with univariate analyses between readmission status and the following patient variables included: mean patient age (p = 0.02); hypertension (p &lt; 0.001); BMI (p = 0.01); morbid obesity (p = 0.002); ASA Classification (p = 0.006); and bleeding disorders (p = 0.03). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age, p = 0.02), OR = 1.03, 95% CI [1.01, 1.06]; hypertension, p &lt; 0.001, OR = 3.82, 95% CI [1.81, 8.06]; BMI, p = 0.01, OR = 1.06, 95% CI [1.01, 1.11]; morbid obesity, p = 0.004, OR = 3.53, 95% CI [1.49, 8.36]. CONCLUSION Our study indicated that only 0.73% of patients were readmitted after their outpatient procedure. Patients who: 1) have BMIs greater than 40; 2) are older in age 3) have hypertension; and 4) a higher ASA Classification were at increased risk for readmission.

Modelling 30-day hospital readmission after discharge for COPD patients based on electronic health records

Chronic Obstructive Pulmonary Disease (COPD) is the third most common chronic disease in China with frequent exacerbations, resulting in increased hospitalization and readmission rate. COPD readmission within 30 days after discharge is an important indicator of care transitions, patient’s quality of life and disease management. Identifying risk factors and improving 30-day readmission prediction help inform appropriate interventions, reducing readmissions and financial burden. This study aimed to develop a 30-day readmission prediction model using decision tree by learning from the data extracted from the electronic health record of COPD patients in Macao. Health records data of COPD inpatients from Kiang Wu Hospital, Macao, from January 1, 2018, to December 31, 2019 were reviewed and analyzed. A total of 782 hospitalizations for AECOPD were enrolled, where the 30-day readmission rate was 26.5% (207). A balanced dataset was randomly generated, where male accounted for 69.1% and mean age was 80.73 years old. Age, length of stay, history of tobacco smoking, hemoglobin, systemic steroids use, antibiotics use and number of hospital admission due to COPD in last 12 months were found to be significant risk factors for 30-day readmission of CODP patients (P < 0.01). A data-driven decision tree-based modelling approach with Bayesian hyperparameter optimization was developed. The mean precision-recall and AUC value for the classifier were 73.85, 73.7 and 0.7506, showing a satisfying prediction performance. The number of hospital admission due to AECOPD in last 12 months, smoke status and patients’ age were the top factors for 30-day readmission in Macao population.

Risk Factors for Readmission and Mortality Following Colonic Surgery: A Consecutive Retrospective Series of More Than 2500 Cases.

Introduction: The optimal strategy to reduce short-term readmission rates following colectomy remains unclear. Identifying possible risk factors can minimize the burden associated with surgical complications leading to readmissions. Materials and Methods: A retrospective review of all adult patients who underwent colectomies between January 2008 and December 2020 in a large tertiary medical center was conducted. Data were collected from patient's medical charts and analyzed. Results: Overall, 2547 patients were included in the study (53% females; mean age 68.3 years). The majority of patients (83%, n = 2112) were operated in an elective setting, whereas 435 patients (17%) underwent emergency colonic resection. Overall, the 30-day readmission rate was 8.3% (n = 218) with an overall 30-day mortality rate of 1.65% (n = 42). Multivariable analysis of possible risk factors for 30-day readmission demonstrated that patient age (odds ratio [OR] 0.98; P = .002), length of stay before surgery (OR 1.01; P = .003), and blood transfusion rate during hospitalization (OR 2.09; P < .001) were all independently associated with an increased risk. Laparoscopic colectomy (OR 0.53; P = .001) was associated with a reduced risk for readmission. Multivariable analysis of risk factors for mortality showed that age (OR 1.10; P < .001), cognitive decline (OR 12.35; P < .001), diabetes (OR 1.00; P = .004), and primary ostomy formation (OR 2.80; P = .006) were all associated with higher mortality. Conclusion: Patient age, history of cognitive decline, and blood transfusion along with a longer hospital stay were all correlated with an increased risk for 30-day patient readmission following colectomy.

Risk factors for ninety-day readmissions following full-endoscopic transforaminal lumbar discectomy for 1542 patients in the biggest spine institutes in Korea.

Endoscopic techniques are becoming popular among spine surgeons because of their advantages. Though the advantages of endoscopic spine surgery are evident and patients can be discharged home within hours of surgery, readmissions can be sought for incomplete relief of leg pain, recurrent disc herniation, and recurrent leg pain. We aim to find out the factors related to the readmission of patients treated for lumbar pathologies. This is a retrospective analysis of the data between the time duration of 2012 and 2022. Patients in the age group of 18-85years, with lumbar disc herniation treated by transforaminal endoscopic lumbar procedures, were included. The patients who were readmitted within 90days were included in the R Group and those who were not were included in the NR group. Univariable and multivariable logistic regression analyses were used to find the risk factors for 90-day readmission. There were a total of 1542 patients enrolled in this study. Sex, number of episodes before admission, hypertension, smoking, BMI, migration, disc height, disc height index, spondylolisthesis, instability, pelvic tilt (PT), and disc cross-sectional area (CSA) were found significant on univariable analysis. Age, spondylolisthesis, instability and muscle CSA were the only variables that were found to be statistically significant on multivariable analysis. This study shows that the elderly age group, presence of spondylolisthesis, segmental instability and decreased muscle cross-sectional area are independent risk factors for 90-day hospital readmissions. Patients having the above risk factors should be carefully counseled regarding the possibility of readmission in the future.

Risk Factors for Thirty-Day Readmission Following Lumbar Surgery: A Meta-Analysis.

Thirty-day readmission is one of the common complications after lumbar surgery. More 30-day readmission increases the total hospitalization, economic burden, and physical pain of patients, delays the progress of postoperative rehabilitation, and even lead to die. Therefore, it is necessary to analyze the risk factors of 30-day readmission following lumbar surgery. We searched for all the clinical trials published from the establishment of the database to May 1, 2022 through the Cochrane Library, Web of Science, Embase, and PubMed. Data including age, American Society of Anesthesiology physical status class, preoperative hematocrit (Hct), diabetes mellitus (DM), current smoker, chronic obstructive pulmonary disease (COPD), length of hospital stay (LHS), operation time, and surgical site infection (SSI) were extracted. We used Review Manager 5.4 for data analysis. Six studies with 30,989 participants were eligible for this meta-analysis. The analysis revealed that there were statistically significant differences in the age (95% confidence interval [CI]:-3.35-2.90, P < 0.001), preoperative Hct (95% CI: 0.75-1.33, P < 0.001), DM (95% CI: 0.56-0.74, P < 0.001), COPD (95% CI: 0.38-0.58, P < 0.001), operation time (95% CI:-35.54-16.18, P < 0.001), LHS (95% CI:-0.54-0.50, P < 0.001), and SSI (95% CI: 0.02-0.03, P<0.001) between no readmission and readmission groups. In terms of the American Society of Anesthesiology physical status class and current smoker, there was no significant effect on the 30-day readmission (P= 0.16 and P= 0.35 respectively). Age, preoperative Hct, DM, COPD, operation time, LHS, and SSI are the danger factors of 30-day readmission following lumbar surgery.

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.