Trends In Readmission Research Articles

Insights into Readmission Trends Following Inpatient Chemotherapy for Acute Lymphoblastic Leukemia: A 30-Day Analysis

Insights into Readmission Trends Following Inpatient Chemotherapy for Acute Lymphoblastic Leukemia: A 30-Day Analysis

National 30-Day Readmission Trends in IBD 2014-2020-Are We Aiming for Improvement?

Background: Inflammatory bowel disease (IBD) prevalence in Eastern Europe is increasing. The 30-day readmission rate is a crucial quality metric in healthcare, reflecting the effectiveness of initial treatment and the continuity of care post-discharge; however, such parameters are rarely analyzed. The aim of this study was to explore the trends in 30-day readmissions among patients with inflammatory bowel disease in Latvia between 2014 and 2020. Methods: This is a retrospective trends study in IBD-ulcerative colitis and Crohn's disease (UC and CD)-patients in Latvia between 2014 and 2020, involving all IBD patients identified in the National Health service database in the International Classification of Diseases-10 (ICD) classification (K50.X and K51.X) and having at least one prescription for IBD diagnoses. We assessed all IBD-related hospitalizations (discharge ICD codes K50X and K51X), as well as hospitalizations potentially related to IBD comorbidities. We analyzed hospitalization trends and obtained the 30 day all-cause readmission rate, disease specific readmission rate and readmission proportion for specific calendar years. Trends in readmissions and the mean length of stay (LOS) for CD and UC were calculated. Results: Despite a decrease in admission rates observed in 2020, the total number of readmissions for CD and UC has increased. Female patients prevailed through the study period and were significantly older than male patients in both the CD and UC groups, p < 0.05. We noted that there was no trend for 30 day all-cause readmission rate for CD (p > 0.05); however, there was a statistically significant trend for 30 day all-cause readmission for UC patients (p-trend = 0.018) in the period from 2014 to 2019. There was a statistically significant trend for CD-specific readmission rate (p < 0.05); however, no statistically significant trend was observed for UC-specific readmission (p > 0.05). An exploratory analysis did not reveal any statistically significant differences between treated and not-treated IBD patients (p > 0.05). The increasing trend is statistically significant over the period 2014-2018 (p < 0.05); however, the trend interrupts in 2020, which can be associated with the COVID-19 global pandemic and the related changes in admission flows where the gastroenterology capacity was reallocated to accommodate increasing numbers of COVID-19 patients. More studies are needed to evaluate the long-term impact of COVID-19 pandemic and 30-day readmissions. No significant dynamics were observed in the mean total hospitalization costs over the 2014-2020 period.

Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020

Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020

Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020

Mitral Transcatheter Edge-to-Edge Repair In-Hospital Outcomes and Mitral Valve Surgery Readmission Trends: National Readmission Database 2018-2020

Cardiovascular and hematologic complications of Hodgkin vs non-Hodgkin lymphoma and readmission trends: A National Readmission Database analysis from years 2016-2020.

e19034 Background: Cardiovascular complications are a leading cause of non-malignant death in lymphoma survivors. We sought to analyze the national readmission trends and evaluate the in-hospital mortality as well as the cardiovascular and hematological complications in lymphoma patients using the National Readmission Database (NRD). Methods: We selected patients aged &gt;=18 years of age, from the NRD between the years 2016-2020 to generate a cohort of Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL) patients using ICD-10 codes. The primary outcome was in-hospital mortality, and the secondary outcome was cardiovascular and hematologic complications of HL vs NHL after adjusting for demographic confounders. We used multivariate logistic regression and propensity score matching (PSM) using STATA v.18. We also analyzed the 30-day readmission trends in these patients. Results: A total of 1,016,338 NHL and 83,036 HL patients were included in the analysis. After matching for demographics confounders, on PSM analysis we found that in-hospital mortality was higher in NHL vs HL (5.9% vs 4.42%; p-value 0.001). The cardiovascular complications that were studied included cardiac tamponade (0.69% in NHL vs 0.4% in HL; p-value 0.001), pericarditis (0.13% in NHL vs 0.14% in HL; p-value 0.717) and anthracycline cardiomyopathy (0.47% in HL vs 0.85% in NHL; p-value 0.001). The hematological outcomes studied included myelodysplastic syndrome (0.71% in NHL vs 0.64% in HL; p-value 0.210), acute leukemia (0.48% in NHL vs 0.44% in HL; p-value 0.43), and myelosuppression (18.59% vs 13.73%; p-value 0.001). A 30-day readmission trend analysis showed a longer length of stay in NHL vs HL (5.34 days vs 4.77 days) while the total inflation-adjusted cost was higher in HL vs NHL (20,989 dollars vs 17176 dollars). Conclusions: An NRD analysis of NHL and HL patient populations from 2016-2020 reflected a slightly increased mortality rate, higher incidence of cardiovascular complications and a longer length of stay in NHL patients. [Table: see text]

Institutional experience with a limb salvage quality improvement initiative to reduce length of stay and readmissions

BackgroundThis article aims to outline the process and present preliminary outcomes of a local quality improvement initiative focusing on length of stay (LOS) and 30-day unplanned readmissions in patients undergoing treatment for peripheral arterial disease. MethodsInitiating with internal data acquisition, our clinical informaticists, adept in Epic data mining, were tasked with monthly query of the database for all patients with peripheral arterial disease managed since May 2021. An automated report of crucial variables, eliminating the need for individual chart review, was thus generated. Studying trends in LOS and readmissions, we set target goals of 7 days for LOS and 11% for 30-day unplanned readmission, referencing the top-decile institutions in the Vizient ranking. To enhance our quality improvement initiative, we formed a comprehensive limb salvage committee, comprising a vascular surgeon, hospitalist, podiatrists, nurses, a case management team, and a clinical researcher. This multidisciplinary team met regularly to review monthly reports, identify trends, and propose improvements. After 6 months of observation, the limb salvage committee finalized a set of recommendations, which were then communicated to the vascular surgery faculty for feedback and subsequent implementation. Monthly outcomes were continuously monitored by the limb salvage committee to assess progress and pinpoint areas necessitating further improvement. ResultsBetween May 2021 and March 2023, 985 consecutive procedures were performed. The average postoperative LOS was 7 ± 10 days, with 35% not meeting the goal. Patients not meeting the LOS goal often had a history of coronary artery disease or congestive heart failure and were admitted initially for nonvascular reasons. The readmission rate was 15%. Recommendations from the limb salvage committee included deferring nonurgent revascularization to outpatient care with prehabilitation for at-risk patients, and early follow-up by a nurse practitioner for wound check and pain management. These recommendations were implemented at the end of March 2023. After implementing these recommendations, 272 cases recorded between April and July 2023 saw a decrease in patients not meeting the target LOS to 27%, and unplanned readmissions decreased to 11%. ConclusionsOur limb salvage quality improvement project has proved efficient in monitoring quality metrics and targeting specific areas in need of improvement. Continuous monitoring is necessary to ensure compliance, track outcomes, and identify areas in need of further improvement. Future studies will assess further the effectiveness of this process in improving patient care.

Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: a real-world observational cohort study

BackgroundAtrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding 30‐day readmission following index admission for AF in the developing world are poorly described. ObjectivesThe study aimed to assess the rate, predictors, and trends of 30-day readmission after index admission for AF in Syria. MethodsWe included adult patients who had an index admission with AF to Latakia’s tertiary center between June 2021 and October 2023. Patients were monitored for readmission for 30 days after index discharge. Data were taken from patients’ medical notes. ResultsA total of 661 patients were included in the final analysis, of which 282 (43%) were readmitted to hospital within 30 days following index admission. Cardiac causes were the most common cause of readmission in 72% of patients, of which 60% were AF. Readmitted patients had a higher median age (62 vs 57; P=0.001) and fewer males (58% vs 51%; P=0.001). In multivariate analysis, factors that independently increased 30-day readmission risk were older age (HR: 1.5, 95% CI: 1.1-1.9), female sex (HR: 1.3, 95% CI: 1.02-1.4), diabetes mellitus (DM) (HR: 1.7, 95% CI: 1.3-2.3) and congestive heart failure (CHF) (HR: 2.2, 95% CI: 1.7-2.9). Most cardiac readmissions happened during the first 15 days (79%). ConclusionAlmost one in two patients were readmitted within 30 days after an index admission for AF. Female sex, advancing age, DM and CHF were independently associated with an increased risk of 30-day readmission.

Trends and impact of comorbidities on Guyon's Canal release for the treatment of Guyon's Canal syndrome: A decade long nationwide analysis

BackgroundGuyon's Canal Syndrome (GCS) is a rare nerve entrapment condition with limited studies exploring the trends of GCS patients undergoing Guyon's Canal release. The aim of this study is to examine the trends associated with GCS: (1) Guyon's Canal release procedures performed; (2) surgically relevant comorbidities; (3) 90-day readmissions; and (4) same-day and 90-day reimbursement. MethodsA retrospective query was performed on the PearlDiver Mariner Database from 2010 to 2020 by CPT code 64719 to identify patients who underwent Guyon's Canal release. A total of 33,3764 patients were identified. Linear regression models were used to analyze trends in procedures performed, comorbidities, readmission, and reimbursement over this period. A P-value less than 0.05 was considered statistically significant. ResultsBetween 2010 and 2020, there was an overall significant decreasing trend in the number of Guyon's Canal release procedures performed (RC, −127.50; p < 0.001). There was an increase in number of GCS patients that had undergone Guyon's Canal release who drink alcohol (RC, 0.33; p < 0.001), are obese (RC, 0.81; p < 0.001), and use tobacco (RC, 0.56; p < 0.004), and decrease number of GCS patients with a history of diabetes (RC, −0.82; p < 0.001), hypothyroidism (RC, −0.56; p < 0.001), PVD (RC, −0.71; p < 0.001), and RA (RC, −0.33; p < 0.001). We also found an overall increasing trend in 90-day readmissions (RC, 0.09; p = 0.019) and increased same-day (RC, 68.09; p < 0.001) and 90-day average reimbursement (RC, 257.15; p < 0.001) from 2010 to 2020. ConclusionThe study demonstrated a decreasing trend in Guyon's Canal release performed in GCS patients but increasing cost of care implicated by the increased 90-day readmissions and same day and 90-day reimbursement. This may be attributed to the comorbidities present in GCS patients undergoing Guyon's Canal release. Therefore, it is imperative when consulting GCS patients with surgically relevant comorbidities to weigh the risk and benefits of the procedure.

Infection-Related Readmissions Are Rising among Patients with Hepatorenal Syndrome: A Nationwide Analysis

Hepatorenal syndrome (HRS) is a unique form of renal dysfunction that results from circulatory hemodynamic dysfunction in advanced liver disease. We aimed to determine longitudinal trends in both all-cause and cause-specific readmissions for HRS in the United States. Using the National Readmission Database (2010–2018), we identified adult HRS patients during index admission via ICD codes. Fisher’s exact test and Cox regression analysis were used to compare proportions and compute adjusted p-values, respectively. Regression models were adjusted for gender, age, the Charlson comorbidity index, median household income, and hospital factors. A total of 169,522 HRS patients were included in the analysis (overall mean age 58.97 years). The incidence of HRS hospitalization increased from 5.30% in 2010 to 5.84% in 2018 (p &lt; 0.01). Over the same duration, all-cause readmission at 30 days showed an overall increasing trend from 19.81% to 19.99% (trend p &lt; 0.01). HRS-specific readmission at 30 days following an index hospitalization ranged from 13.60 to 15.98, with an overall increasing trend in the study period (2010–2018). While cirrhosis, hepatic failure, and infection were uniformly the three most common causes of readmission throughout the study period, cirrhosis and infection showed an upward trend. Rising readmissions, especially with hepatic failure and infection, in HRS patients signal a need for national strategies to manage and prevent HRS towards reducing its healthcare burden.

Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Anemia.

Anemia is associated with worse clinical outcomes in cardiac patients. We aim to investigate the clinical outcomes and readmission rates in anemic patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR). The National Readmissions Database (NRD) from 2015 to 2018 was queried using the ICD-10 codes to identify patients admitted for TEER. Patients were divided into anemic and non-anemic sub-groups. Univariate and multivariate analyses were performed. Cardiovascular outcomes were assessed between cohorts at index admission and readmissions at 30, 90, and 180 days. STATA v.17 was used for analysis (StataCorp LLC, Texas, USA). Our final cohort included 28,995 patients who had undergone TEER in the United States between 2016 and 2019. About 1,434 (4.9%) had a diagnosis of anemia. The mean age of patients who had TEER with anemia and TEER without anemia was 76.9 ± 10.8 vs. 77.7 ± 10.2, respectively. In the adjusted model, anemic patients had higher odds of acute kidney injury (AKI) (aOR 2.21; 95% [CI 1.81-2.6; p<0.001]), HF (aOR 1.75; 95% [CI 1.28-2.3; p<0.001]), myocardial infarction (MI) (aOR 1.54; 95% [CI 1.01-2.33; p<0.041]), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.72; 95% [CI 1.2-9-2.3; p<0.001]), and net adverse event (aOR 1.85; 95% [CI 1.32-2.59; p<0.001]). The anemic group's readmission rate was overall higher at 30, 90, and 180 days from 2016 to 2019. Anemia was associated with increased adverse clinical outcomes and more extended hospital stays in patients with anemia who had undergone TEER procedures compared to the non-anemic group.

Managing incisional wounds with Prevena VAC therapy in lower-extremity vascular surgery: A comparative study.

Vascular surgical site infections have been reported with an overall incidence of 5-10% for patients undergoing arterial interventions and as high as 10-20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence. A prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained. A total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; p = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; p < .0001). The results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.

Trends in racial/ethnic disparities in postpartum hospital readmissions in California from 1997 to 2018

Postpartum readmission is an important indicator of postpartum morbidity. The likelihood of postpartum readmission is highest for Black individuals. However, it is unclear whether the likelihood of postpartum readmission has changed over time according to race/ethnicity. Little is also known about the factors that contribute to these trends. This study aimed to: (1) examine trends in postpartum readmission by race/ethnicity, (2) examine if prenatal or clinical factors explain the trends, and (3) investigate if racial/ethnic disparities changed over time. We examined trends in postpartum readmission, defined as hospitalization within 42 days after birth hospitalization discharge, using live birth and fetal death certificates linked to delivery discharge records from 10,711,289 births in California from 1997 to 2018. We used multivariable logistic regression models that included year and year-squared (to allow for nonlinear trends), overall and stratified by race/ethnicity, to estimate the annual change in postpartum readmission during the study period, represented by odds ratios and 95% confidence intervals. We then adjusted models for prenatal (eg, patient demographics) and clinical (eg, gestational age, mode of birth) factors. To determine whether racial/ethnic disparities changed over time, we calculated risk ratios for 1997 and 2018 by comparing the predicted probabilities from the race-specific, unadjusted logistic regression models. The overall incidence of postpartum readmission was 10 per 1000 births (17.4/1000 births for non-Hispanic Black, 10/1000 for non-Hispanic White, 7.9/1000 for non-Hispanic Asian/Pacific Islander, and 9.6/1000 for Hispanic individuals). Odds of readmission increased for all groups during the study period; the increase was greatest for Black individuals (42% vs 21%-29% for the other groups). After adjustment for prenatal and clinical factors, the increase in odds was similar for Black and White individuals (12%). The disparity in postpartum readmission rates relative to White individuals increased for Black individuals (risk ratio, 1.68 in 1997 and 1.90 in 2018) and more modestly for Hispanic individuals (risk ratio, 1.02 in 1997 and 1.05 in 2018) during the study period. Asian/Pacific Islander individuals continued to have lower risk than White individuals during the study period (risk ratio, 0.87 in 1997 and 0.82 in 2018). The rate of postpartum readmissions increased from 1997 to 2018 in California across all racial/ethnic groups, with the greatest increase observed for Black individuals. Racial/ethnic differences in the trend were more modest after adjustment for prenatal and clinical factors. It is important to find ways to prevent further increases in postpartum readmission, especially among groups at highest risk.

746 Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes

746 Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes. To identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC. This retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023. TORS for OPSCC. Univariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined. A weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]). In this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.

Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes

ObjectiveTo evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes. MethodsThe 2010–2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed. Risk factors associated with peripartum cardiomyopathy were analyzed with unadjusted and adjusted logistic regression models with odds ratios as measures of effect. Risk for severe adverse outcomes associated with peripartum cardiomyopathy was analyzed. Trends were analyzed with joinpoint regression. ResultsOf 39,790,772 delivery hospitalizations identified, 9,210 were complicated by a diagnosis of peripartum cardiomyopathy (2.3 per 10,000). Risk for a 5-month readmission with a peripartum cardiomyopathy diagnosis was 4.8 per 10,000. Factors associated with peripartum cardiomyopathy during deliveries included preeclampsia with severe features (OR 18.9, 95 % CI 17.2, 20.7), preeclampsia without severe features (OR 6.9, 95 % CI 6.1, 7.8), multiple gestation (OR 4.7, 95 % CI 4.1, 5.3), chronic hypertension (OR 10.1, 95 % CI 8.9, 11.3), and older maternal age. Associations were attenuated but retained significance in adjusted models. Similar estimates were found when evaluating associations with postpartum readmissions. Peripartum cardiomyopathy readmissions were associated with 10 % of overall postpartum deaths, 21 % of cardiac arrest/ventricular fibrillation diagnoses, 18 % of extracorporeal membrane oxygenation cases, and 40 % of cardiogenic shock. In joinpoint analysis, peripartum cardiomyopathy increased significantly during delivery hospitalizations (average annual percent change [AAPC] 2.2 %, 95 % CI 1.0 %, 3.4 %) but not postpartum readmissions (AAPC 0.0 %, 95 % CI −1.6 %, 1.6 %). ConclusionRisk for peripartum cardiomyopathy increased during delivery hospitalizations over the study period. Obstetric conditions such as preeclampsia and chronic medical conditions that are increasing in prevalence in the obstetric population were associated with the highest odds of peripartum cardiomyopathy.

The Long-Term Effect of Financial Penalties on 30-Day Hospital Readmission Rates.

Although the immediate effect of financial penalties imposed by the Hospital Readmissions Reduction Program (HRRP) was a decrease in 30-day hospital readmission rates, the long-term effects are unclear. The authors studied 30-day readmissions before and immediately after HRRP penalties and during the most recent period before the COVID-19 pandemic and examined whether readmission trends differed between penalized and non-penalized hospitals. Centers for Medicare & Medicaid Services hospital archive data and US Census Bureau data were used to analyze hospital characteristics, including readmission penalty status, and hospital service area (HSA) demographic information, respectively. These two datasets were matched by HSA crosswalk files, available through the Dartmouth Atlas files. Using data from 2005-2008 as baseline, the authors examined hospital readmission trends before (2008-2011) and after penalties (during three periods: 2011-2014, 2014-2017, 2017-2019). Mixed linear models were used to examine readmission trends through periods, and differences by hospital penalty status without and with adjustment for hospital characteristics and HSA demographic information. For all hospitals combined, rates for 2008-2011 vs. 2011-2014 were as follows: pneumonia, 18.6% vs. 17.0%; heart failure (HF), 24.8% vs. 22.0%; acute myocardial infarction (AMI), 19.7% vs. 17.0% (p < 0.001 for all three conditions). Rates for 2014-2017 vs. 2017-2019 were as follows: pneumonia, 16.8% vs. 16.8% (p = 0.87), HF, 21.7% vs. 21.9% (p < 0.001); AMI, 16.0% vs. 15.8% (p < 0.001). Compared to penalized hospitals, using difference-in-differences, non-penalized hospitals had a significantly greater increase for two conditions between the 2014-2017 and 2017-2019 periods: pneumonia 0.34%, p < 0.001; and HF 0.24%, p = 0.002. Long-term readmission rates are lower than pre-HRRP rates, with recent trends decreasing further for AMI, stabilizing for pneumonia, and increasing for HF.

Microbial Trends in Infection-related Readmissions Following Radical Cystectomy for Bladder Cancer

To report microbial pathogens detected at infection-related readmissions, including their susceptibility to antimicrobials. A retrospective review of 785 patients who underwent radical cystectomy for bladder cancer at a tertiary center in Denmark between 2009 and 2019. All patients received prophylactic cefuroxime preoperatively and pivmecillinam at stent- or catheter removal. Data were collected through the national medical records and microbiology database. The primary outcome was readmission rate and pathogens detected at infection-related readmissions. Univariable and multivariable regression analyses were carried out to identify risk factors of readmission. Within 90days of surgery, 225 (29%) patients experienced at least one infection-related readmission. The most common pathogen identified was Enterococcus spp (24% of all positive samples). In blood cultures, the most dominant species were Escherichia coli (29%) and Staphylococcus spp (26%). Due to the heterogeneity in microbial species identified, more than one-third of the bacteria where mecillinam was tested showed resistance. Most isolates were susceptible to piperacillin+tazobactam. Orthotopic neobladder and continent cutaneous reservoir were associated with the highest risk of infection-related readmission compared to ileal conduit (odds ratios 2.78 [95%CI 1.66;4.65] and 3.08 [95%CI 1.58;5.98], respectively). Patients with diabetes had an increased risk of infection-related readmission compared to patients without diabetes (odds ratio 1.67 [95%CI 1.02;2.73]). Nearly one-third of all patients experienced at least one postoperative infection-related readmission with a wide range of microbial etiologies. Generalizability of our results is uncertain, but the data can be used to plan interventional trials of antibiotic prophylaxis.

Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005-2018: A Collaboration of Cohort Studies.

Hospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005-2018 among adult PWH in NA-ACCORD. Linear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (<400 copies/mL), and cohort. We examined 20 189 hospitalizations among 8823 PWH (73% cisgender men, 38% White, 38% Black). PWH hospitalized in 2018 versus 2005 had higher median age (54 vs 44 years), CD4 count (469 vs 274 cells/μL), and virologic suppression (83% vs 49%). Unadjusted 30-day readmissions decreased from 20.1% (95% confidence interval [CI], 17.9%-22.3%) in 2005 to 16.3% (95% CI, 14.1%-18.5%) in 2018. Absolute annual trends were -0.34% (95% CI, -.48% to -.19%) in unadjusted and -0.19% (95% CI, -.35% to -.02%) in adjusted analyses. By index hospitalization reason, there were significant adjusted decreases only for cardiovascular and psychiatric hospitalizations. Readmission reason was most frequently in the same diagnostic category as the index hospitalization. Readmissions decreased over 2005-2018 but remained higher than the general population's. Significant decreases after adjusting for CD4 count and virologic suppression suggest that factors alongside improved ART contributed to lower readmissions. Efforts are needed to further prevent readmissions in PWH.

Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries

ObjectivesTo assess across seven hospitals from six different countries the extent to which the COVID-19 pandemic affected the volumes of orthopaedic hospital admissions and patient outcomes for non-COVID-19 patients admitted...

A nationwide study of temporal trends of cause-specific hospital readmissions in patients with heart failure.

The impact of hospital readmissions on the outcomes of heart failure (HF) patients is well known. However, data on temporal trends of cause-specific hospital readmissions in these patients are limited. From 1987 to 2014, we identified and followed up for 1year 608135 patients ≥18years hospitalized with HF according to the International Classification of Diseases (ICD) 9 and 10 from the National Inpatient Register. Readmissions for cardiovascular (CVD) and non-CVD causes and co-morbidities were defined according to ICD-9 and ICD-10 codes. We analysed trends in the incidence rate of readmissions, the median time to the first rehospitalization, and the time to readmission, stratified by sex, age groups and cause of rehospitalization using linear regression. During our study, 1year all-cause mortality decreased (β=-4.93, P<0.0001), but the incidence rate of readmissions per 1000 person-years remained unchanged. The readmission rate for CVD causes decreased; in contrast, the readmission rate increased across all age and sex groups for non-CVD causes. Analysing the patients by study periods (1987-1997, 1998-2007 and 2008-2014), CVD and non-CVD co-morbidities had a statistically significant increasing trend (P<0.001). The median time in hospital decreased and the median time to the first readmission were almost unchanged. Contrary to a declining mortality rate, the incidence rate of readmissions saw no change, possibly because of divergent trends in cause-specific readmissions. An increasing rate of readmissions for non-CVD causes underscores the importance of optimising multimorbidity management to reduce the risk of readmissions in patients with HF.