Risk Of Readmission Research Articles

Epidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.

Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes. This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis. Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001). One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

Frailty and its association with readmissions in patients with rheumatoid arthritis: A national readmissions database study.

It remains unknown whether frailty status confers an increased risk of readmission in patients with rheumatoid arthritis (RA). From the 2018 Nationwide Readmissions Database (NRD), we identified adult patients (age ≥ 18years) admitted with a diagnosis of RA between January to June 2018. Utilizing validated Hospital Frailty Score, patients' frailty risk score was calculated at the time of index admission and categorized into frail (score ≥ 5) and non-frail (score < 5) groups. Our primary outcomes of interest were (1) 180- day readmission rate (2) inpatient mortality; secondary outcomes included prolonged length of stay, LOS (LOS ≥ 7days), and costs of hospitalization. Multivariable Cox proportional hazard analysis was performed to evaluate the independent effect of frailty adjusting for confounding variables. 133,187 patients met inclusion criteria, with mean age 67.7years, of whom 64,131 (48.1%) patients were categorized as frail. The rate of readmission was significantly higher in the frail (56.60%) compared to the non-frail group (30.61%). At index hospitalization, frail patients also had significantly higher inpatient mortality compared to non-frail patients (3.36% vs 0.39%, p < 0.005), longer LOS (26.24% vs 7.82%, p < 0.005). On multivariate analysis frailty was independently associated with a 9% increased risk of readmission (adjusted hazard ratio, 1.09; 95% confidence interval, 1.08 - 1.11). People with RA who are frail have higher rates of readmission than those who are not frail. These findings are crucial in identifying at-risk patients with RA and in discharge planning after hospitalization. Key Points • People with RA who are frail have higher rates of readmission than those who are not frail. • Frail RA patients are also at higher risk of hospitalization-related adverse outcomes, including inpatient mortality and longer hospital stay. • Sepsis is the most common cause for readmission identified in frail patients with RA. • These findings suggest that frailty may be a useful metric in identifying patients with RA at an increased risk of adverse health outcomes.

Postpartum readmission after unscheduled cesarean delivery in patients with class 3 obesity.

Identify risk factors for postpartum readmission in class 3 obese patients undergoing unscheduled cesarean deliveries. Retrospective cohort study of patients with BMI ≥ 40 kg/m2 undergoing unscheduled cesarean delivery from 2017-2020 comparing patients with and without postpartum readmission (unexpected admission, emergency room/overnight observation visit, unscheduled outpatient visit, or ambulatory surgery within 30 days). Medical history, operative data, and postpartum outcomes were compared between the cohorts. "The electronic medical record was queried to identify cesarean deliveries documented as 'unscheduled'". 255 of 1273 identified patients (20.0%) had a postpartum readmission. Median BMI was similar between the cohorts (44.2 kg/m2, IQR [41.8, 47.9] vs. 44.8 kg/m2 [42.0, 48.9], p= 0.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy (p= 0.046). A sub-group exploratory analysis excluding outpatient and emergency room visits demonstrated higher rates of type II diabetes mellitus in patient's with postpartum readmission (11.5% vs 4.6%, p= 0.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0% vs 84.3%, p= 0.014) in comparison to gentamicin/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9% vs 64.3%, p= 0.027). On multivariable logistic regression analysis, smoking history (OR 1.44, 95% CI 1.06-1.96, p= 0.0220) and hypertensive disease (OR 1.57, 95% CI 1.18-2.09, p 0.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR 0.59, 95% CI 0.41-0.84, p= 0.004) and vaginal sterile preparation (OR 0.72, 95% CI 0.54- 0.95, p= 0.022) were associated with decreased risk of readmission. In class 3 obese patients, a history of smoking and a diagnosis of hypertensive disease associate with increased risk of postpartum readmission. Perioperative antibiotic prophylaxis with cefazolin along with vaginal sterile preparation associate with decreased risk of postpartum readmission.

Ability of clinical data to predict readmission in Child and Adolescent Mental Health Services

This study addresses the challenge of predicting readmissions in Child and Adolescent Mental Health Services (CAMHS) by analyzing the predictability of readmissions over short, medium, and long term periods. Using health records spanning 35 years, which included 22,643 patients and 30,938 episodes of care, we focused on the episode of care as a central unit, defined as a referral-discharge cycle that incorporates assessments and interventions. Data pre-processing involved handling missing values, normalizing, and transforming data, while resolving issues related to overlapping episodes and correcting registration errors where possible. Readmission prediction was inferred from electronic health records (EHR), as this variable was not directly recorded. A binary classifier distinguished between readmitted and non-readmitted patients, followed by a multi-class classifier to categorize readmissions based on timeframes: short (within 6 months), medium (6 months - 2 years), and long (more than 2 years). Several predictive models were evaluated based on metrics like AUC, F1-score, precision, and recall, and the K-prototype algorithm was employed to explore similarities between episodes through clustering. The optimal binary classifier (Oversampled Gradient Boosting) achieved an AUC of 0.7005, while the multi-class classifier (Oversampled Random Forest) reached an AUC of 0.6368. The K-prototype resulted in three clusters as optimal (SI: 0.256, CI: 4473.64). Despite identifying relationships between care intensity, case complexity, and readmission risk, generalizing these findings proved difficult, partly because clinicians often avoid discharging patients likely to be readmitted. Overall, while this dataset offers insights into patient care and service patterns, predicting readmissions remains challenging, suggesting a need for improved analytical models that consider patient development, disease progression, and intervention effects.

Exploring the association between surgical out-of-pocket costs and healthcare quality outcomes: A retrospective cohort study

Rising out-of-pocket (OOP) costs paid by healthcare consumers can inhibit access to necessary healthcare. Yet it is unclear if higher OOP payments are associated with better care quality. This study aimed to identify the individual and socio-contextual predictors of OOP costs and to explore the association between OOP costs and quality of care outcomes for four surgical procedures. A retrospective cohort analysis was conducted using data from Medibank Private health insurance members aged ≥18 years who underwent hip replacement, knee replacement, cholecystectomy and radical prostatectomy during 2015-2020 across >300 hospitals in Australia. Healthcare quality outcomes investigated were hospital-acquired complications (HACs), unplanned intensive care unit (ICU) admissions, prolonged length of stay (LOS) and readmissions within 28 days. Socio-contextual determinants of OOP costs examined were patient demographics, socioeconomic status, health insurance, and procedure complexity. Generalized linear mixed modelling examined the risk of each outcome, adjusting for covariates and considering patients clustering within surgeons and hospitals. Patients were more likely to pay OOP costs if they were aged 65-74 years compared to aged 18-44 years for all four surgical procedures. No association between OOP payments and the risk of HACs, ICU admission, or hospital readmission was identified. Patients who paid OOP costs were less likely to have a prolonged LOS for all four procedure types. Higher OOP payments weren't linked to improved care quality except for shorter hospital stays. Greater transparency on OOP costs is needed to inform consumer decisions.

Remdesivir Effectiveness in Reducing the Risk of 30-day Readmission in Vulnerable Patients Hospitalized for COVID-19: A Retrospective US Cohort Study Using Propensity Scores.

Reducing hospital readmission offer potential benefits for patients, providers, payers, and policymakers to improve quality of healthcare, reduce cost, and improve patient experience. We investigated effectiveness of remdesivir in reducing 30-day COVID-19-related readmission during the Omicron era, including older adults and those with underlying immunocompromising conditions. This retrospective study utilized the US PINC AI Healthcare Database to identify adult patients discharged alive from an index COVID-19 hospitalization between December 01, 2021 and February 29, 2024. Odds of 30-day COVID-19-related readmission to the same hospital were compared between patients who received remdesivir vs those not, after balancing characteristics of two groups using inverse probability of treatment weighting (IPTW). Analyses were stratified by maximum supplemental oxygen requirement during index hospitalization. Of 326,033 patients hospitalized for COVID-19 during study period, 210,586 patients met the eligibility criteria. Of these, 109,551 (52%) patients were treated with remdesivir. After IPTW, lower odds of 30-day COVID-19-related readmission were observed in patients who received remdesivir vs those who did not, in the overall population (3.3% vs 4.2%, respectively; odds ratio [95% confidence interval]: 0.78 [0.75-0.80]), elderly population (3.7% vs 4.7%, respectively; 0.78 [0.75-0.81]), and those with underlying immunocompromising conditions (5.3% vs 6.2%, respectively; 0.86 [0.80-0.92]). These results were consistent irrespective of supplemental oxygen requirements. Treating patients hospitalized for COVID-19 with remdesivir was associated with a significantly lower likelihood of 30-day COVID-19-related readmission across all patients discharged alive from the initial COVID-19 hospitalization, including older adults and those with underlying immunocompromising conditions.

Influence of patient characteristics and discharge destination on circulatory system diseases readmissions among older heart failure patients

IntroductionHeart failure (HF) prevalence is rising, particularly among older people, constituting a significant cause of hospitalization. Discharge destinations, including nursing homes (NH), play a crucial role in post-hospitalization outcomes but remain underexplored. MethodsA retrospective study utilizing the Spanish National Health System's Minimum Basic Data Set identified older HF patients (≥75 years) discharged from acute hospitals between 2016 and 2019. Patient demographics, comorbidities, and discharge destinations were analyzed. Predictors of 30-day readmissions for circulatory system diseases and NH admission were assessed using multilevel logistic regression models. ResultsOf 157,330 index episodes, 2.8 % were discharged to NH, more frequently in females. Thirty-day readmission incidence was 9.3 %, with HF exacerbations accounting for 80.6 % of cases. Predictors of 30-day readmission included renal failure (OR: 1.38), severe hematological disorders (OR: 1.30), and history of coronary revascularization surgery (OR: 1.23), while discharge to NH lowered the risk (OR: 0.70). Admission to NH was associated with neurological diseases (OR: 3.27), cardiogenic shock (OR: 3.19), stroke (OR: 2.68), advanced cancer (OR: 2.51), with higher likelihood among females (OR: 1.23). After propensity score-matched analysis, patients discharged to NH had significantly lower 30-day readmission rates than those discharged home (6.4 % vs. 28.9 %, adjusted OR: 0.169). ConclusionDischarge to NH is infrequent but associated with lower readmission risk for older HF patients. Female gender, specific comorbidities, and acute conditions influence NH admission. Enhanced collaboration between HF units and NH is crucial for optimizing post-hospitalization outcomes. Further research and policy initiatives are needed to improve care coordination and reduce HF readmissions.

Metabolic syndrome increases the length of stay and medical complications after hip and knee arthroplasty: results from a prospective cohort study of 2,901 patients.

Metabolic syndrome (MetS) affects more than 60% of the patients having a hip or knee arthroplasty due to osteoarthritis. As it is debated whether metabolic syndrome increases the risk of complications, we aimed to investigate the length of stay (LOS) and risk of readmission at 30 and 90 days after surgery, including causes of readmission. We conducted a prospective cohort study of 2,901 patients undergoing hip and knee arthroplasty from May 2017 to November 2019. Physical examination, blood samples, and medical history from national registries determined the diagnosis of metabolic syndrome from the International Diabetes Federation definition. We used multivariate linear regression to investigate differences in LOS according to MetS, and binary regression to investigate the risk and causes of readmission within 30 and 90 days, including 95% confidence intervals (CI) and P values. Patients with MetS showed a slightly longer LOS (0.20 days, CI 0.10-0.29) and had an increased risk of readmission within 90 days (adjusted relative risk [RR] 1.2, CI 1.0-1.4; P = 0.02), but not within 30 days (adjusted RR 1.1, CI 0.9-1.4; P = 0.3) after surgery. Cardiovascular disease was the dominant cause of readmission. Although patients with MetS do not experience a clinically relevant longer LOS after hip and knee arthroplasty, they have an increased risk of 90-day readmission mainly due to cardiovascular complications, which should be considered when planning surgical care in this group of patients.

The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.

Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032). ■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission. ■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission. ■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary. ■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission. To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery. A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females. Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032). The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.

7555 Gender-Related Differences in Outcomes of Patients With Diabetic Ketoacidosis: An Analysis of the National Readmission Database

Abstract Disclosure: E. Ahsan: None. C. Lesniak: None. M. Akula: None. K. Hu: None. K. Chalasani: None. R. Ong: None. S. Holland: None. M. Hossain: None. J. Cheng: None. J. Heaton: None. Introduction: Diabetic ketoacidosis (DKA), one of the most serious complications of diabetes, is a significant cause of morbidity and mortality. Hospitalizations for DKA have increased significantly over the past two decades. Despite this, there is a notable absence of data on gender-related variations in the clinical characteristics and outcomes of individuals hospitalized with DKA. Understanding these distinctions is crucial for optimizing disease prevention and care. Thus, the primary aim of this study was to explore whether gender influences the outcomes of DKA. Methodology: We analyzed the National Readmissions Database (NRD) from 2016 to 2020 by evaluating patients admitted with a primary diagnosis of DKA without coma. Patients were included if they were at least 18 years old and admitted between January and November. Patients meeting inclusion criteria were stratified by sex. The groups were assessed for 30-day readmissions, all causes of mortality, length of stay, and total cost. Descriptive statistics, Cox proportional hazards, and adjusted Wald tests were used to compare the groups. Results: Between 2016 and 2020, 642,431 patients met the inclusion criteria with a median age of 44, of which 46.5% were female and 53.5% were male. Early readmission occurred in 33,639.20 females and 31,101.92 males. Cox regression analysis showed a significant difference in readmission risk for female patients than males (HR 1.20, 95% CI 1.17-1.22, P = &amp;lt;0.001). The length of stay was higher in male patients than in female patients (adjusted Wald test, P =&amp;lt;0.001). Inpatient mortality was higher in females than in males (Cox regression analysis, P = 0.009). Total cost was higher in males compared to females (adjusted Wald test, P = &amp;lt;0.001). Conclusion: Regrettably, the majority of studies on diabetic ketoacidosis (DKA) have not given due attention to gender differences. Our study, however, reveals statistically significant variations in in-hospital mortality and 30-day readmission rates between men and women hospitalized with DKA, with women exhibiting higher rates than men. Additionally, the length of stay and total cost were found to be higher for men. To comprehend the underlying reasons for these distinctions, further investigations are warranted. Early introduction and intensification of insulin therapy may prove beneficial for this patient group in mitigating the risk of DKA and other complications associated with diabetes mellitus. Presentation: 6/2/2024

Associations Between Short-Term Postoperative Outcomes and Immunocompromised Status in Patients Undergoing Sacrocolpopexy.

Few data exist on the impact of immunosuppression on perioperative outcomes in women undergoing sacrocolpopexy. The objective of this study was to compare differences in 30-day perioperative morbidity in immunocompromised versus non-immunocompromised women undergoing sacrocolpopexy (SCP). We hypothesize that compared with the non-immunocompromised group, immunocompromised women undergoing SCP experience worse composite 30-day postoperative outcomes. Retrospective cohort of female patients aged 18years or older who underwent sacrocolpopexy from 2012 to 2017. Current procedural terminology (CPT) codes 57280 and 57425 identified sacrocolpopexy in the American College of Surgeons-National Surgical Quality Improvement Project database. The primary exposure was a binary indicator of immunocompromised status, and the primary outcome was a composite indicator of readmission, reoperation, or a severe adverse event 30days after surgery. Marginal standardization, a G-computation method, was used to estimate risk ratios (RR) and 95% confidence intervals (CI) representing the association between exposure and outcome. A total of 13,505 women underwent SCP between 2012 and 2017. Of those, 2,625 (19.4%) had an indicator of immunocompromised status, with diabetes and smoking being most common. The risk of the composite adverse outcome in immunocompromised women was 7.3% versus 4.6% in non-immunocompromised women. After adjusting for age, race, ethnicity, and body mass index, immunocompromised women experienced 54% increased relative risk of an adverse outcome, compared with non-immunocompromised women (RR = 1.54; 95% CI: 1.31, 1.82). Immunocompromised status, most commonly caused by diabetes and smoking, increases the risk of readmission, reoperation, and a severe adverse event within 30days of sacrocolpopexy.

Rehospitalizaciones precoces y tardías tras el cierre percutáneo de la orejuela izquierda

Introduction and objectivesPercutaneous left atrial appendage closure (LAAC) has emerged as a nonpharmacological alternative for the prevention of thromboembolic events in patients with nonvalvular atrial fibrillation. However, there are few data on readmissions after LACC. The aim of this study was to determine the rate of early (≤30 days) and late (31-365 days) readmission after LAAC, and to assess the predictors and clinical impact of rehospitalization. MethodsThis multicenter study included 1419 consecutive patients who underwent LAAC. The median follow-up was 33 [17-55] months, and follow-up was complete in all but 54 (3.8%) patients. The primary endpoint was readmissions for any cause. Logistic regression and Cox regression analysis were performed to determine the predictors of readmission and its clinical impact. ResultsA total of 257 (18.1%) patients were readmitted within the first year after LAAC (3.2% early, 14.9% late). The most common causes of readmission were bleeding (24.5%) and heart failure (20.6%). A previous gastrointestinal bleeding event was associated with a higher risk of early readmission (OR, 2.65; 95%CI, 1.23-5.71). The factors associated with a higher risk of late readmission were a lower body mass index (HR, 0.96-95%CI, 0.93-0.99), diabetes (HR, 1.38-95%CI, 1.02-1.86), chronic kidney disease (HR, 1.60; 95%CI, 1.21-2.13), and previous heart failure (HR, 1.69; 95%CI, 1.26-2.27). Both early (HR, 2.12-95%CI, 1.22-3.70) and late (HR, 1.75; 95%CI, 1.41-2.17) readmissions were associated with a higher risk of 2-year mortality. ConclusionsReadmissions within the first year after LAAC were common, mainly related to bleeding and heart failure events, and associated with patients’ comorbidity burden. Readmission after LAAC confered a higher risk of mortality during the first 2 years after the procedure.

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.

Harnessing the Power of Complementarity Between Smart Tracking Technology and Associated Health Information Technologies: Longitudinal Study.

Smart tracking technology (STT) that was applied for clinical use has the potential to reduce 30-day all-cause readmission risk through streamlining clinical workflows with improved accuracy, mobility, and efficiency. However, previously published literature has inadequately addressed the joint effects of STT for clinical use and its complementary health ITs (HITs) in this context. Furthermore, while previous studies have discussed the symbiotic and pooled complementarity effects among different HITs, there is a lack of evidence-based research specifically examining the complementarity effects between STT for clinical use and other relevant HITs. Through a complementarity theory lens, this study aims to examine the joint effects of STT for clinical use and 3 relevant HITs on 30-day all-cause readmission risk. These HITs are STT for supply chain management, mobile IT, and health information exchange (HIE). Specifically, this study examines whether the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and whether symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. This study uses a longitudinal in-patient dataset, including 879,122 in-patient hospital admissions for 347,949 patients in 61 hospitals located in Florida and New York in the United States, from 2014 to 2015. Logistic regression was applied to assess the effect of HITs on readmission risks. Time and hospital fixed effects were controlled in the regression model. Robust standard errors (SEs) were used to account for potential heteroskedasticity. These errors were further clustered at the patient level to consider possible correlations within the patient groups. The interaction between STT for clinical use and STT for supply chain management, mobile IT, and HIE was negatively associated with 30-day readmission risk, with coefficients of -0.0352 (P=.003), -0.0520 (P<.001), and -0.0216 (P=.04), respectively. These results indicate that the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Furthermore, the joint effects of these HITs varied depending on the hospital affiliation and patients' disease types. Our results reveal that while individual HIT implementations have varying impacts on 30-day readmission risk, their joint effects are often associated with a reduction in 30-day readmission risk. This study substantially contributes to HIT value literature by quantifying the complementarity effects among 4 different types of HITs: STT for clinical use, STT for supply chain management, mobile IT, and HIE. It further offers practical implications for hospitals to maximize the benefits of their complementary HITs in reducing the 30-day readmission risk in their respective care scenarios.

Risk factors for early readmission to hospital in patients with malignancy-related ascites: a retrospective cohort study.

Malignancy-related ascites (MRA) is a common serious complication of many advanced malignant tumors with high morbidity and mortality. The high hospital expenditures induced by unplanned readmission in patients with MRA have become an urgent issue to the public. We aimed to overall assess the unplanned early readmission rate of patients with MRA and explore the potential risk factors for such readmission. A retrospective cohort study based on 2018 Nationwide Readmissions Database was performed and patients with MRA were recruited into the analysis. The primary outcome was unplanned 30-day readmission rate and inpatient outcomes. The multivariate logistic regression analysis was performed to evaluate the potential risk factors for such early readmission. Data obtained from 32,457 patients with MRA were analyzed, and of these 7,799 individuals (24.03%) were unplanned readmitted within 30-day follow-up. The mortality rate in the readmitted population was 15.15%. Patients at younger age were at a higher risk of readmission. The morbidities including hypertension (OR=1.117, 95%CI: 1.054-1.184), hyperlipemia (OR=1.075, 95%CI: 1.009-1.146) and diabetes (OR=1.118, 95%CI: 1.053-1.188), gastrointestinal malignancies and peritoneal procedure significantly increased the risk of 30-day readmission in patients with MRA. More than one in five patients with MRA was unplanned readmitted within 30-day follow-up. The above risk factors should be timely intervened and the corresponding medical care should be strengthened in patients with MRA to lessen the unplanned readmission and improve the readmission outcomes.

Effect of frailty on unplanned readmission in older adults: A systematic review

BackgroundFrailty and hospital readmissions are two major problems for older people because of their impact on health, quality of life and healthcare systems. The aims of this study were to investigate the relationship between frailty and unplanned readmissions at 30, 90, 180 days and 1 year in hospitalised older people, and to identify the most relevant tools for assessing readmission risk in different clinical settings to facilitate systematic identification of this high-risk population by healthcare professionals. MethodThis review was based on a systematic search of the MEDLINE, EMBASE and SCIENCEDIRECT databases for articles published between January 2011 and December 2021 that examined the association between frailty and unplanned readmission in hospitalised adults aged 65 years and over using identified validated tools. Results44 eligible studies out of 1362 were included in a descriptive analysis. Sixteen countries were represented with older adults hospitalised in medical, surgical, post-acute care and rehabilitation, and emergency departments. Up to 84.5% of frail older adults had an unplanned readmission. Of the 21 tools identified, the Hospital Frailty Risk Score (HFRS), the Frailty Index (FI), its derivatives, the Clinical Frailty Scale (CFS) and the Fried model were the most widely used and relevant tools for identifying the association between frailty and unplanned readmission. ConclusionFrailty is widely associated with readmission risk in older adults. The HFRS, FI, CFS and Fried model appear to be the most commonly used tools to assess frailty and prevent unplanned readmissions.

Follow-Up of a Sample of Patients with Substance Use Disorder After Completing a Rehabilitation Program in a Continuous Care Unit in Eastern Province of Saudi Arabia, from 2012 to 2022: A Retrospective Study.

There has been limited research on Saudi patients with substance use disorders (SUDs) that has examined and assessed the psychotherapy modalities utilized in rehabilitation. Therefore, there is a need to evaluate rehabilitation programs in the continuous care unit of the Erada Complex for Mental Health, Eastern Province, Saudi Arabia. The purpose of this study was to compare patients who finished the program with those who did not in order to determine the rate of re-admission and recurrence. Male patients (1160) aged >20 who had been diagnosed with SUDs were included in this retrospective cohort study. After ruling out mood, anxiety, psychosis, and other psychiatric disorders, they commenced a one-year rehabilitation program. Six months after leaving the facility, all participants who completed the program or not were re-admitted had relapses and underwent urine toxicological tests. Data analysis showed that 34.97% of patients completed the program, while 65.03% of patients did not complete the program. Within 6 months of follow-up after discharge, re-admission occurred in only 13.1% of patients that completed the program, but patients who did not complete the program had a readmission rate that reached 26.9% with statistical significance. In comparison between the two groups regarding relapse without needing admission, there was a significant difference between patients who completed the program (reached 14%) and those who did not complete the program (reached 28.9%). With a logistic regression model, the only significant predictor was completion of the program (the odds ratio was 0.42). The present results in this study revealed that patients with substance use disorder who had finished the specific rehabilitation program in the continuous care unit had lower risk of relapse and re-admission. Further studies are needed to elucidate the importance of the rehabilitation programs in the management of substance use disorder.

Preoperative Osteoporosis Is Associated with Increased Healthcare Utilization and Compromised Pain and Function Improvement after Primary Total Hip Arthroplasty: A Prospective Cohort Analysis

Osteoporosis (OP) has been linked to complications after total hip arthroplasty (THA), but its impact on healthcare utilization and patient-reported outcomes remains unclear. This study aimed to evaluate the association between: 1) pre-THA OP and healthcare utilization as well as patient-reported pain and function outcome measures; and 2) Dual Energy X-ray Absorptiometry (DEXA) scan-based T-scores and the aforementioned outcomes. A retrospective analysis of prospectively collected data of primary THA (2015 to 2018) was performed (n = 5,321) from a validated academic institutional database of a large North American tertiary health care system; of which 4,074 (76.6%) completed one-year follow-up. Outcomes included prolonged length of stay [LOS] > 3 days, discharge disposition, 90-day readmission, and one-year reoperation, as well as Hip Disability and Osteoarthritis Outcome Score (HOOS]) Pain, HOOS-function (PS), and minimal clinically important difference thresholds (MCID), and satisfaction. The prevalence of OP pre-THA was 56.9%, of which 39.8% were not prescribed OP medications and 15.3% had a DEXA scan. Compared to those who did not have OP, those who had OP were independently associated with higher odds of prolonged LOS, non-home discharge, 90-day readmission, and 1-year reoperation (P < 0.005). Furthermore, they had significantly higher odds of failing to achieve MCID (odds ratio (OR): 1.41 (95% confidence interval (CI): 1.06 to 1.89)) for HOOS-PS and satisfaction (OR: 1.5 (95% CI: 1.16 to 1.93)) at 1-year. Higher T-scores were associated with lower odds of prolonged LOS, non-home discharge, failure to achieve MCID in HOOS-Pain, and HOOS-PS. Over half of patients had OP, however, only 15.3% of patients had a DEXA scan prior to THA. Patients who had OP were at higher risk of prolonged LOS, non-home discharge, 90-day readmission, and one-year reoperation in addition to poor pain/function improvement and dissatisfaction one year after THA.

Exploring Recidivism in Cardiac Surgical ICU: Can this Understanding Translate to Enhanced Patient Outcomes?

The need for reinstitution of intensive care unit (ICU) care ("recidivism") in post-cardiac surgery patients is associated with increased morbidity, mortality, resource use, and healthcare costs. Recidivism is propounded as a quality indicator of ICU care. There is a paucity of studies from India regarding cardiac surgical ICU readmissions, their outcomes, and risk factors. Nested case-control study including 1,711 consecutive adult patients who underwent cardiac surgery over a two-year period at a tertiary care institute. The patients were grouped into recidival (R) and control (C) groups. The reasons for readmission, outcomes, and predictive risk factors were analyzed. Fifty-four of 1,711 (3.1%) patients were readmitted to ICU, main reasons being cardiac arrhythmias (24, 41%), pericardial effusion (9, 15.2%), and infection (8, 13.5%). Readmission was significantly higher for valvular interventions (39 patients, 24.3%, mitral valve 25 patients) than coronary artery bypass grafting (13, 10.6%), P value 0.003*. On multivariate analysis, EuroSCORE 2 (>5), age, surgical reexploration, postoperative pulmonary complications, and infections were independently associated with a need for ICU readmission. The mortality rate among the readmitted patients was 7.4% compared to 1.4% overall mortality. The mean total postoperative length of stay was significantly longer for recidival patients (17.6 ± 14 days vs 7.6 ± 2.4 days; P < 0.0001). Recidivism is associated with longer hospital stay, suboptimal outcomes as well higher risk of mortality. Postoperative cardiac dysrhythmia was the most common cause of recidivism in our cohort. Early identification of patients at risk for recidivism and timely management of cardiopulmonary complications can translate to better outcomes.

In-hospital mortality, readmission, and prolonged length of stay risk prediction leveraging historical electronic patient records.

This study aimed to investigate the predictive capabilities of historical patient records to predict patient adverse outcomes such as mortality, readmission, and prolonged length of stay (PLOS). Leveraging a de-identified dataset from a tertiary care university hospital, we developed an eXplainable Artificial Intelligence (XAI) framework combining tree-based and traditional machine learning (ML) models with interpretations and statistical analysis of predictors of mortality, readmission, and PLOS. Our framework demonstrated exceptional predictive performance with a notable area under the receiver operating characteristic (AUROC) of 0.9625 and an area under the precision-recall curve (AUPRC) of 0.8575 for 30-day mortality at discharge and an AUROC of 0.9545 and AUPRC of 0.8419 at admission. For the readmission and PLOS risk, the highest AUROC achieved were 0.8198 and 0.9797, respectively. The tree-based models consistently outperformed the traditional ML models in all 4 prediction tasks. The key predictors were age, derived temporal features, routine laboratory tests, and diagnostic and procedural codes. The study underscores the potential of leveraging medical history for enhanced hospital predictive analytics. We present an accurate and intuitive framework for early warning models that can be easily implemented in the current and developing digital health platforms to predict adverse outcomes accurately.