Risk Factors For 30-day Readmission Research Articles

Risk and Causes of 30-Day Readmissions Following Extracorporeal Membrane Oxygenation Support for Cardiogenic Shock

Purpose Cardiogenic shock (CS) is associated with significant mortality, morbidity and healthcare costs. Extracorporeal membrane oxygenation (ECMO) is increasingly used in CS. Inpatient mortality is high, but readmission risk in survivors is not well studied. We conducted our study to identify risk and causes of 30-day readmission following ECMO. Methods Using the 2016 Healthcare Cost and Utilization Project National Readmission Database, we studied the incidence and causes of 30-day readmissions following ECMO support for CS (January to November 2016). Patients ICD codes . Logistic regression models were used to explore risk factors for 30-day readmissions. Results Out of 62,302 patients admitted for CS, 1490 (2.4%) were supported with ECMO. Median time from admission to ECMO placement was 2 [0-6] days. A total of 661 (44%%) patients survived to discharge. Out of those, 158 (24%) were readmitted within 30 days; (52.5%) occurred within 12 days. Causes of readmissions are shown in figure. Factors associated with 30-day readmissions included (multivariable model): discharge to skilled nursing facility (odds ratio [OR], 3.25; 95% confidence interval (CI) [1.66-6.39], P home health care (OR 2.47; 95% CI [1.31-4.63], P ventricular assist device (OR 2.85; 95% CI [1.52-5.33], P Conclusion Patients with cardiogenic shock who are supported with ECMO have high risk of mortality and 30-day readmission rate following discharge. Identifying patient at high risk of readmission may help targeting resources to improve long-term outcomes.

Risk Factors for 30-Day Readmission of Otolaryngology Patients

Risk Factors for 30-Day Readmission of Otolaryngology Patients

Are Urinary Biomarkers Better Than Acute Kidney Injury Duration for Predicting Readmission?

Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.

Predictors of Adverse Outcomes in the Management of Mandibular Fractures.

Mandibular fractures are the most common isolated facial fractures in the United States. Various risk factors have been associated with increased rates of postoperative complications. However, national outcome reports are limited and data are conflicting. Using a national multi-institutional database, the authors sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation. Retrospective review of the American College of Surgeons National Surgical Quality Improvement database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015 using current procedural terminology codes. Primary outcomes included: wound complications, overall complications, as well as readmission and reoperation rates. Multivariate regression analysis was performed to adjust for confounders. A total of 953 patients were eligible for analysis. Mean patient age was 34.5 years, 84% were males, and 50% were active smokers. Wound complications, overall complications, 30-day reoperation, and readmission occurred in 4.0%, 7.9%, 2.2%, and 33% of patients, respectively. Age was a significant risk factor for 30-day readmission (odds ratio [OR] = 1.06, P = 0.01), reoperation (OR = 1.05, P = 0.01), and overall complications (OR = 1.03, P = 0.02) on multivariate analysis, and smoking was a significant risk factor for 30-day reoperation (OR = 4.86, P = 0.03). The analysis identified age as an independent risk factor for readmission, reoperation, and overall complications. Smokers were also nearly 5 times as likely to undergo additional surgery. This is particularly important given that over half of patients were active smokers, highlighting the importance of perioperative patient education and smoking cessation within this population.

Risk factors for 30-day readmission following hip arthroscopy.

Hip arthroscopy is known to be safe with low rates of postoperative complications. The purpose of this study is to evaluate hip arthroscopy cases in a national surgical database to identify risk factors associated with readmission. The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2016 for current procedural terminology billing codes related to hip arthroscopy. International Classification of Diseases diagnostic codes were used to exclude cases involving infection, fracture, or open procedures. Univariate and multivariate analyses were performed to identify risk factors associated with 30-day readmission. 1493 patients were identified who had undergone hip arthroscopy. The most common procedures were labral resection or chondroplasty (n = 589, 39.5%) and femoroplasty (n = 527, 35.3%). The 30-day complication rate was 1.7% and the most common complications following the procedure were bleeding (n = 12, 0.8%) superficial infections (n = 5, 0.3%), and returning to the operating room (n = 4, 0.3%). The 30-day readmission rate was 1.3%. On multivariate analysis, hypertension requiring anti-hypertensive medication (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4-8.7) and chronic corticosteroid or immunosuppressant use (OR 7.2; 95% CI 1.9-26.7) were identified as independent risk factors for readmission. There was no difference in complication rates when hip arthroscopy was performed with isolated femoroplasty (n = 340), isolated acetabuloplasty (n = 103), both (n = 187) or neither (n = 863). These findings confirm that the 30-day readmission (1.3%) and complication rate (1.7%) are low for isolated hip arthroscopy procedures; however, hypertension and chronic steroid use are independent risk factors for readmission. Retrospective comparative study, Level III.

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States.

The burden of cirrhosis on the healthcare system is substantial and growing. Our objectives were to estimate the readmission rates and hospitalization costs as well as to identify risk factors for 90-day readmission in patients with cirrhosis. We conducted a weighted analysis of the 2014 Nationwide Readmission Database to identify adult patients with cirrhosis-related complications in the United States and assessed readmission rates at 30, 60 and 90days post-index hospitalization. Predictors of 90-day readmissions were identified using weighted regression models adjusting for patient and hospital characteristics; the national estimate of hospitalization costs was also calculated. Of the 58954 patients admitted with cirrhosis-related complications in 2014, 14910 (25%) were readmitted within 90days because of cirrhosis-related complications. The main causes of readmission were ascites (56%), hepatic encephalopathy (47%) and bleeding oesophageal varices (9%). Independent predictors of 90-day readmissions were male sex (adjusted OR [aOR]: 1.08, 95% CI, 1.04-1.13), age <60 (aOR: 1.27, 95% CI, 1.22-1.32), privately insured (aOR: 0.74, 95% CI, 0.70-0.77), having ≥3 comorbid conditions (aOR: 1.27, 95% CI, 1.14-1.42) and being discharged against medical advice (aOR: 1.41, 95% CI, 1.25-1.59). The weighted cumulative national cost estimate of the index admission was $1.8 billion, compared to $0.5 billion for readmission. A quarter of patients admitted with cirrhosis-related complications were readmitted within 90days, representing a significant economic burden related to readmission of this population. Interventions and resource allocations to reduce readmission rates among cirrhotic patients is critical.

Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time.

BackgroundThere is no mechanism that matches hard-to-place kidneys with the most appropriate candidate. Thus, unwanted kidney offers are typically to recipients with long renal replacement time (vintage) which is a strong risk factor for mortality and graft failure, and in combination with prolonged cold ischemia time (CIT), may promote interactive effects on outcomes.MethodsConsecutive adult isolated kidney transplants between October 2015 and December 2017 were stratified by vintage younger than 1 year and CIT longer than 30 hours.ResultsLong (n = 169) relative to short (n = 93) vintage recipients were significantly more likely to be younger (32.2 years vs 56.9 years, P = 0.02), black race (40.8% vs 18.3%, P = 0.02), have higher estimated posttransplant survival (52.6 vs 42.0, P = 0.04), and have a comorbid condition (45.6% vs 30.1%, P = 0.02); they were less likely to receive a donation after circulatory death kidney (27.8% vs 39.8%, P = 0.05). Long vintage was significantly associated with length of stay longer than 4 days (45.5% vs 30.1%, P = 0.02), and 30-day readmission (37.3% vs 22.6%, P = 0.02) but not additional operations (17.8% vs 15.1%, P = 0.58), short-term patient mortality (3.0% vs 2.2%, P = 0.70), or overall graft survival (P = 0.23). On multivariate logistic regression, long vintage remained an independent risk factor for 30-day readmission (adjusted odds ratio, 1.92; 95% confidence interval, 1.06-3.47); however, there was no interaction of vintage and CIT for this outcome (P = 0.84).ConclusionsReadmission is significantly associated with pretransplant dialysis duration; however, CIT is not a modifying factor for this outcome.

Cohort study of risk factors for 30-day readmission after abdominal aortic aneurysm repair.

Background: We conducted a retrospective cohort study of thirty-day readmission after abdominal aortic aneurysm (AAA) repair. Patients and methods: Inpatients (2009-2016) undergoing elective AAA repair were selected from the multicenter Cerner Health Facts® database using ICD-9 procedure codes. We identified characteristics associated with 30-day readmission with chi-square analysis and logistic regression. Results: 4,723 patients undergoing elective AAA procedures were identified; 3,101 endovascular aneurysm repairs (EVAR) and 1,622 open procedures. Readmission differed by procedure type (6.5 % EVAR vs. 9.3 % open, p =.0005). Multivariable logistic regression found that patients undergoing EVAR were less likely to be readmitted (OR 0.71, 95 % CI 0.54-0.92) than patients undergoing open repair. The following risk factors were associated with 30-day readmission following any AAA repair: surgical site infection during the index admission (OR 2.79, 95 % CI 1.25-6.22), age (OR 1.03, 95 % CI 1.01-1.05), receipt of bronchodilators (OR 1.34, 95 % CI 1.06-1.70) or steroids (OR 1.45, 95 % CI 1.04-2.02), serum potassium > 5.2 mEq/L (OR 1.89, 95 % CI 1.16-3.06), and higher Charlson co-morbidity scores (OR 1.12, 95 % CI 1.04-1.21). Subgroup analysis revealed that age (OR 1.02, 95 % CI 1.01-1.04), higher Charlson comorbidity scores (OR 1.20, 95 % CI 1.09-1.33), and receipt of post-operative bronchodilators (OR 1.39, 95 % CI 1.03-1.88) were risk factors for 30-day readmission following EVAR. After open procedures, readmission was associated with surgical site infection during the index admission (OR 2.91, 95 % CI 1.17-7.28), chronic heart failure (OR 2.18, 95 % CI 1.22-3.89), and receipt of post-operative steroids (OR 1.92, 95 % CI 1.24-2.96). The most common infections were pneumonia after open procedures and urinary tract infection after EVAR. Conclusions: The risk factor most associated with 30-day readmission after elective AAA repair was surgical site infection. Awareness of these risk factors and vulnerable groups may help identify high-risk patients who could benefit from increased surveillance programs to reduce readmission.

Thirty days are inadequate for assessing readmission following complex hepatopancreatobiliary procedures.

Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2years) following Hepatopancreatobiliary (HPB) surgery in the state of New York. The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2years following surgery to identify all-cause readmissions. Factors for readmissions included patient demographics, comorbidities, perioperative complications, surgery type, and academic status. Multivariable generalized linear mixed models were performed to evaluate risk factors for readmissions. There were 6207 complex HPB procedures with 1272 (20.49%) unplanned 30-day readmissions, 816 (13.15%) unplanned 31-90-day readmissions, 1678 (27.03%) unplanned 91-day to 1-year readmissions, and 1404 (22.62%) 1-2-year readmissions. After adjusting for other possible confounding factors, risk factors for 30-day readmissions include surgery type, as pancreatectomy and gallbladder patients are more likely to have a 30-day readmission than hepatectomy patients, facility type, as academic centers are more likely to have a readmission, male gender, presence of any comorbidity, and peri-operative complications. Risk factors for 31-90-day readmissions include race, insurance group, any comorbidity or any peri-operative complication, and 30-day readmissions. Risk factors for 91-day to 1-year readmissions include male gender, race, any comorbidity, 30-day readmissions, and 31-90 days' readmissions. Risk factors for 1-2-year readmissions include presence of any comorbidity, and previous 91-day to 1-year readmissions. The 30-day readmission window is an inadequate, but predictive, measure of total readmission following complex HPB procedures.

Identifying Risk Factors for 30-Day Readmissions After Triple Arthrodesis Surgery

Rigid flatfoot deformity is a debilitating condition that can be managed by triple arthrodesis surgery. Triple arthrodesis has the potential to restore health-related quality of life, but it is also associated with several complications. Few studies have examined the 30-day readmission rates after triple arthrodesis. The objective of this study was to investigate risk factors for 30-day all-cause readmissions after triple arthrodesis. The nationwide readmission database was queried from 2013. By using International Classification of Disease, Ninth Revision, procedure codes, all triple arthrodesis procedures were identified. Demographic factors, comorbidities, insurance status, and hospital characteristics were statistically compared between patients who experienced a 30-day readmission and those who did not. Multivariable logistic regression was used to identify independent risk factors for 30-day readmission. Overall, 1916 triple arthrodesis cases were identified. The overall 30-day readmission rate after triple arthrodesis was 4.6%. Univariate analysis revealed a statistically higher proportion of patients with electrolyte abnormalities (13.8% vs 4.6%; p < .01) in the patients who were readmitted within 30 days compared with those who were not. Multivariable analysis demonstrated Medicaid insurance, relative to private insurance, as the only statistically significant predictor of 30-day readmission with an odds ratio of 4.43 (p < .05). These results suggest that patients of lower socioeconomic status may be at a greater risk for development of a short-term readmission after triple arthrodesis surgery. These findings are important for surgeon and patient communication, counseling, and postoperative care when choosing to pursue triple arthrodesis surgery.

Risk factors for readmission within thirty days following revision total hip arthroplasty

BackgroundThe number of total hip arthroplasties (THA) being performed has been steadily increasing for decades. With increased primary THA surgical volume, revision THA numbers are also increasing at a steady pace. With the aging, increasingly comorbid patient populations and newly imposed financial penalties for hospitals with high readmission rates, refining understanding of factors influencing readmission following THA is a research priority. We hypothesize that numerous preoperative medical comorbidities and postoperative medical complications will emerge as significant positive risk factors for 30-day readmission. MethodsACS-NSQIP database identified patients who underwent revision THA from 2005 to 2015. The primary outcome assessed was hospital readmission within 30 days. Patient demographics, preoperative comorbidities, laboratory studies, operative characteristics, and postsurgical complications were compared between readmitted and non-readmitted patients. Logistic regression identified significant independent risk factors for 30-day readmission among these variables. Results10,032 patients underwent revision THA in the ACS-NSQIP from 2005 to 2015; 855 (8.5%) were readmitted within 30-days. Increasing age, the presence of preoperative comorbidities, high ASA class, and increased operative time were significant positively associated independent risk factors for 30-day readmission. Several postoperative medical and surgical complications such as myocardial infarction, stroke, pneumonia, and sepsis demonstrated significant positive associations with readmission. ConclusionIdentifying and understanding risk factors associated with readmission allows for the implementation of evidence-based interventions aimed at minimizing risk and reducing 30-day readmission rates following revision THA.

Trends and Risk Factors for 30-Day Readmissions in Patients With Acute Cholangitis: Analysis From the National Readmission Database: Presidential Poster Award

Introduction: Without prompt management, acute cholangitis (AC) can be associated with significant morbidity and high risk of readmissions. Hospital readmissions are associated with adverse healthcare outcomes and 30-day readmission rate is used as a quality measure. We used national readmission database (NRD) to identify trends and risk factors for 30-day readmissions in patients with AC. Methods: We conducted a retrospective cohort study of adult patients admitted with AC from 2010-2014 and Q1-Q3 of 2015 by extracting data from NRD. First admission with a primary diagnosis of acute cholangitis (ICD-9 code: 576.1) was considered as the index admission and any admission after index admission was considered a readmission regardless of the primary diagnosis. Multivariable regression analyses were performed to assess the association between index characteristics and 30-day readmission rates. Results: From 52,906 AC index admissions, overall 30-day readmission rate was 21.48% and no significant difference was noted in the readmission rates across the study period (figure-1; table-1). There was an increase in the overall hospital charges for readmissions (p=0.039), while a reduction was noted in the death rate during the first readmissions(p=0.004). Recurrent cholangitis (14%), septicemia (6.4%) and mechanical complication of bile duct prosthesis (3%) were the most common reasons for readmissions. The risk of readmission was significantly higher in patients with pancreatic neoplasm (OR=1.6, 95% CI: 1.4-1.8), percutaneous biliary procedures (OR=1.4, 95% CI: 1.2-1.6) and acute respiratory failure (OR=1.2, 95% CI: 1.0-1.15). Other factors contributing to increased risk of readmissions include patients with Charlson comorbidity index >3, diabetes, those discharged to short-term hospital or with home health care as compared to routine discharge and length of stay >3 days (table-2). Readmission risk was significantly lower in patients who underwent ERCP (OR=0.80, 95% CI: 0.73-0.88) or cholecystectomy (OR=0.54, 95% CI: 0.43-0.69). Risk was also lower in those with cholelithiasis/choledocholithiasis or morbid obesity. Conclusion: AC is associated with a very high 30-day readmission rate of over 21%. Patients with malignant biliary obstruction, increased comorbidities, and those who undergo percutaneous drainage rather than ERCP seem to be at highest risk. Our study findings are helpful to develop strategies to decrease readmission rates and improve outcomes in patients with AC.66_A Figure 1. Kaplan-Meier plot: 30-day readmission rates for acute cholangitis from 2010-2015.66_B Figure 2. Trends in readmission rates and associated characteristics66_C Figure 3. Multivariable Analysis: Factors affecting with 30-day Readmission

INSURANCE DISPARITY OF 30-DAY READMISSION IN NONELDERLY PATIENTS WITH ANGIOEDEMA: A NATIONWIDE ANALYSIS

SESSION TITLE: Allergy and Airway SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Angioedema is one of the critical diseases that may require hospitalization and even intubation. We studied risk factors of 30-day readmission in patients under age 65 admitted with angioedema and identified insurance disparity as an important risk factor. METHODS: We did a retrospective cohort study using the 2014 National Readmission Database. We included discharges that were non-elective with a primary diagnosis ICD-9 code indicating Angioedema and age less than 65. A readmission is defined as the first admission to hospital for any non-trauma cause within 30 days of the index admission. The primary outcome is the 30-day readmission rate. Secondary outcomes include mortality rate, most common primary causes for readmission, readmission risk factors were identified using multivariate regression analysis. RESULTS: The total number of admissions for angioedema in non-elderly population was 10,075. The mean age was 49.0, 53.1% of the total admissions were female. The all-cause 30-day mortality rate in Angioedema patients was 0.4% with an in-hospital mortality rate of 0.3%. 15.6% of admitted angioedema patients were intubated and 12.5% were intubated within 24 hours. The all cause and the angioedema-specific 30-day readmission rate was 5.4% and 0.2%, respectively. The in-hospital mortality rate for the readmitted patients was 2.0%. The most common cause for readmission include (top 1-3): Unspecified septicemia, Angioneurotic edema, Fluid overload. Various possible risk factors were identified using univariate regression analysis. The odds ratios (ORs) and p-values were calculated using multivariable logistic regression and independent predictors for readmission were identified: Medicaid (OR 1.72; 95% CI 1.18-2.50) and Medicare (OR 2.19; 95% CI 1.48-3.22) after adjusting for sex, age group, hospital volume quintile, teaching status, COPD, early intubation (within 24 hours and 72 hours of admission), adverse drug effect and clinical comorbidity (asthma was not adjusted given all readmitted patients had asthma); higher Charlson comorbidity score was also a risk factor of higher readmission rates. CONCLUSIONS: Angioedema has a low mortality rate both in-hospital and within 30 days in non-elderly population. The readmission rate is low but patients with Medicaid or Medicare are more likely to get readmitted within 30 days after discharge. Readmissions are mostly for non-angioedema causes. Early intubation is not uncommon for hospitalized angioedema patients but it is not identified a risk factor for readmission. CLINICAL IMPLICATIONS: Higher readmission rates among non-elderly angioedema patients with Medicaid or Medicare may reflect their poor health literacy and limited access to primary care and allergy/immunology specialist given their insurance status. These patients may need special attention and more detailed instructions before discharge to decrease further readmission and related healthcare burden. DISCLOSURES: No relevant relationships by Xiaowen Fan, source=Web Response No relevant relationships by Changchuan Jiang, source=Web Response No relevant relationships by Yiming Luo, source=Web Response No relevant relationships by BING YUE, source=Web Response

A Clinical Risk Scoring Tool to Predict Readmission After Cardiac Surgery: An Ontario Administrative and Clinical Population Database Study

BackgroundReducing readmission after cardiac surgery remains a quality improvement priority yet most readmission risk models examine only coronary artery bypass grafting (CABG). Our objective was to develop a predictive risk score for readmission after discharge in cardiac surgery. MethodsAll adults > 18 years undergoing isolated CABG, isolated/multiple valve, or combined CABG/valve surgery from 2008 to 2016 in Ontario were eligible. Risk factors for 30-day readmission after discharge were obtained through linkages of the CorHealth Ontario Cardiac Registry to other administrative health databases. Hazard ratios (HR) for risk factors were calculated using Cox proportional hazards regression with 95% confidence intervals (95% CI). We developed a clinical risk scoring tool weighted by beta coefficients from the final model. Discrimination and calibration was performed using c-statistics and comparing the predicted with observed probabilities across deciles of predicted risk. ResultsA total of 63,336 patients underwent CABG and/or valve surgery from 2008 to 2016. The 30-day readmission rate was 11.5% overall. Patients who were readmitted were older with higher incidences of cardiac comorbidities compared with nonreadmitted patients. Significant risk factors for readmission from the final model were prolonged length of stay (HR: 1.45; 95% CI: 1.57, 1.86; P < 0.0001), isolated valve surgery (HR: 1.35; 95% CI: 1.26, 1.44; P < 0.0001), in-hospital complications of sepsis (HR: 1.47; 95% CI: 1.05, 2.07; P = 0.024), and acute myocardial infarction (HR: 1.36; 95% CI: 1.09, 1.71; P = 0.007). A clinical risk scoring tool with 22 variables was derived that delineated patients into 1 of 5 risk quintiles. The c-statistic for the overall model was 0.63. ConclusionsReadmission after cardiac surgery is common and moderately predictable in this contemporary cohort.

Abstract: Predictors of Adverse Outcomes in the Management of Mandibular Fractures: An Analysis of 953 Cases

PURPOSE: Mandibular fractures are the most common isolated facial fractures in the United States and often require surgical treatment with open reduction and internal fixation to prevent infection and promote adequate bone healing. Various clinical risk factors have been associated with increased rates of postoperative complications, including smoking, substance abuse, and surgical approach. However, national outcomes reports are limited, and data are conflicting. Using a national multi-institutional database, we sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation. METHODS: Retrospective review of the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015. Case distribution was based on available CPT codes and included open treatment of mandible fracture with external fixation (21454), open treatment of mandible fracture with and without interdental fixation (21462, 21461), and open treatment of complex fractures involving multiple approaches (21470). Preoperative demographic data and postoperative outcomes were analyzed. Primary outcomes included: wound complications (superficial surgical site infection (SSI), deep SSI, and wound dehiscence), overall complications (wound complications and/or medical complications), as well as 30-day readmission and reoperation rates. For risk factors significant on univariate analysis, multivariate analysis was performed to control for confounders. RESULTS: Review of the database identified 953 eligible patients who underwent surgical treatment of mandibular fractures. Mean age was 34.5 years and 84% of the cohort was male. Fifty percent of patients were active smokers. Wound complications occurred in 38 patients (4.0%) and the overall complication rate was 7.9%. The 30-day reoperation and readmission rates were 2.2% and 3.3%, respectively. Multivariate analysis demonstrated age to be a significant risk factor for 30-day readmission (OR = 1.06, p=0.01) and reoperation (OR = 1.05, p=0.01), as well as overall complications (OR = 1.03, p=0.02). Additionally, active smoking was a significant risk factor for 30-day reoperation (OR = 4.86, p=0.03). The odds of readmission for smokers was more than 3 times higher than non-smokers (OR=3.25; 95% CI 0.93–11.43); however, this approached but failed to reach our threshold for statistical significance (p=0.07). CONCLUSION: Our analysis demonstrates that surgical treatment of mandibular fractures can be performed safely and with low rates of wound and overall complications. However, increased age is an independent risk factor for readmission, reoperation, and overall complications. Active smoking was also found to be an independent risk factor for reoperation, with active smokers nearly five times as likely to undergo additional surgery. This is a particularly important finding given that over half of all mandibular fracture patients in our nationwide study were active tobacco users, highlighting the importance of patient education and smoking cessation in the perioperative period within this population.

Incidence and Predictors of 30-Day Readmission Among Patients Hospitalized for Chronic Pancreatitis.

Chronic pancreatitis (CP) hospitalizations along with associated morbidity and costs are increasing. The goal of this study was to use the National Readmission Database to identify the incidence and risk factors for 30-day readmissions among patients with CP. We performed a retrospective analysis of National Readmission Database from January 2013 to December 2013 to determine patient demographic and clinical characteristics predictive of 30-day hospital readmission for adult patients (aged >18 years) discharged with a principle diagnosis of CP. A survey logistic regression model was used to determine the predictive value of selected variables for 30-day readmission. In 2013, 12,545 admissions with primary diagnosis of CP were noted, and 30.4% were readmitted within 30 days. Cholecystectomy (odds ratio [OR], 0.53; P = 0.0024) or endoscopic retrograde cholangiopancreatography (OR, 0.70; P = 0.01) during index admission was associated with decreased all-cause readmissions. Pancreatectomy during index admission was associated with reduced (OR, 0.2; P = 0.0005) pancreatitis-related readmissions. Hospital readmissions for CP are frequent and pose a significant healthcare burden. Performing cholecystectomy, endoscopic retrograde cholangiopancreatography, or pancreatectomy during index admission was associated with reduced odds of readmission.

Risk factors for 30-day readmission after adrenalectomy

Readmissions represent a substantial burden to the health care system. Risk factors for 30-day readmission after adrenalectomy were examined. Patients who underwent adrenalectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2015. Among 4,221 patients who underwent adrenalectomy, 216 (5.1%) were readmitted. On multivariate analysis, pre-operative predictive factors associated with readmission were American Society of Anesthesiologists classification (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.8), disseminated cancer (OR 1.6, CI 1.1-2.5), and adrenal injury (OR 10.9, CI 1.8-68.9). Elective procedures had fewer readmissions (OR 0.50, CI 0.33-0.76). and procedures with greater relative value units had greater readmission rates (OR 1.01, CI 1.004-1.02). An open adrenalectomy (21% of patients) had a higher rate of readmission than a laparoscopic approach (8.0% vs 4.3%, OR 1.5, CI 1.1-2.0). Postoperative risk factors affecting readmission included reoperations (OR 3.2, CI 1.3-8.0), wound complications (OR 6.6, CI 3.8-11.7), systemic infection (OR 6.5, CI 3.9-10.7), renal complications (OR 7.1, CI 2.6-19.2), venous thrombotic events (OR 11.3, CI 5.6-22.6), and discharge to home (OR 0.40, CI 0.22-0.73). Encouraging the appropriate use of laparoscopic adrenalectomy, preventing venous thrombotic events and surgical infections, and improving early post-operative follow-up in high-risk patients may decrease readmissions.

Identifying risk factors for 30-day readmission events among American Indian patients with diabetes in the Four Corners region of the southwest from 2009 to 2016.

ObjectiveThe objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest.Research design and methodsData from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses.ResultsOf 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission.ConclusionsReadmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission.

Incidence, causes and risk factors for 30-day readmission after radical gastrectomy for gastric cancer: a retrospective study of 2,023 patients

The aim of this retrospective study was to investigate the incidence of, causes and risk factors for readmission to hospital ≤30 days after discharge of patients who underwent radical gastrectomy for gastric cancer. A total of 2,023 patients underwent radical gastrectomy operations from November 2010 to July 2017 in our hospital. Of these, 60 patients (3.0%) were readmitted within 30 days after their original discharge. The median time span between the index discharge and readmission was 14 days and the median time for readmission was 8 days. The main reasons for readmission were intestinal obstruction (n = 10, 16.7%), intra-abdominal fluid collection (n = 9, 15.0%), abdominal pain (n = 7, 11.7%), nutritional difficulty (n = 4, 6.7%) and anastomotic leakage (n = 4, 6.7%). Five patients (8.3%) required intensive care and 4 patients (6.7%) died from sudden cardiac arrest, gastrointestinal bleeding, sepsis or multiple organ dysfunctions. Multivariate analysis revealed that post-operative complications (Odds Ratio = 5.116, 95% confidence interval: 2.885–9.073, P < 0.001) was the only independent risk factor for readmission. Thus, appropriate strategies on discharge and close follow-ups for these high-risk patients should be drawn up in order to enhance significantly their quality of care.

Predischarge and Postdischarge Risk Factors for Hospital Readmission Among Patients With Diabetes.

Hospital readmission within 30 days of discharge (30-d readmission) is an undesirable outcome. Readmission of patients with diabetes is common and costly. Most of the studies that have examined readmission risk factors among diabetes patients did not include potentially important clinical data. To provide a more comprehensive understanding of 30-day readmission risk factors among patients with diabetes based on predischarge and postdischarge data. In this retrospective cohort study, 48 variables were evaluated for association with readmission by multivariable logistic regression. In total, 17,284 adult diabetes patients with 44,203 hospital discharges from an urban academic medical center between January 1, 2004 and December 1, 2012. The outcome was all-cause 30-day readmission. Model performance was assessed by c-statistic. The 30-day readmission rate was 20.4%, and the median time to readmission was 11 days. A total of 27 factors were statistically significant and independently associated with 30-day readmission (P<0.05). The c-statistic was 0.82. The strongest risk factors were lack of a postdischarge outpatient visit within 30 days, hospital length-of-stay, prior discharge within 90 days, discharge against medical advice, sociodemographics, comorbidities, and admission laboratory values. A diagnosis of hypertension, preadmission sulfonylurea use, admission to an intensive care unit, sex, and age were not associated with readmission in univariate analysis. There are numerous risk factors for 30-day readmission among patients with diabetes. Postdischarge factors add to the predictive accuracy achieved by predischarge factors. A better understanding of readmission risk may ultimately lead to lowering that risk.