Utilization Project Nationwide Readmissions Database Research Articles

Diabetic Ketoacidosis and Adverse Outcomes Among Pregnant Individuals With Pregestational Diabetes in the United States, 2010-2020.

To assess the frequency of, risk factors for, and adverse outcomes associated with diabetic ketoacidosis (DKA) at delivery hospitalization among individuals with pregestational diabetes (type 1 and 2 diabetes mellitus) and secondarily to evaluate the frequency of and risk factors for antepartum and postpartum hospitalizations for DKA. We conducted a serial, cross-sectional study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2010 to 2020 of pregnant individuals with pregestational diabetes hospitalized for delivery. The exposures were 1) sociodemographic and clinical risk factors for DKA and 2) DKA. The outcomes were DKA at delivery hospitalization, maternal morbidity (nontransfusion severe maternal morbidity (SMM), critical care procedures, cardiac complications, acute renal failure, and transfusion), and adverse pregnancy outcomes (preterm birth, hypertensive disorders of pregnancy, and cesarean delivery) and secondarily DKA at antepartum and postpartum hospitalizations. Of 392,796 deliveries in individuals with pregestational diabetes (27.2% type 1 diabetes, 72.8% type 2 diabetes), there were 4,778 cases of DKA at delivery hospitalization (89.1% type 1 diabetes, 10.9% type 2 diabetes). The frequency of DKA at delivery hospitalization was 1.2% (4.0% with type 1 diabetes, 0.2% with type 2 diabetes), and the mean annual percentage change was 10.8% (95% CI, 8.2-13.2%). Diabetic ketoacidosis at delivery hospitalization was significantly more likely among those who had type 1 diabetes compared with those with type 2 diabetes, who were younger in age, who delivered at larger and metropolitan hospitals, and who had Medicaid insurance, lower income, multiple gestations, and prior psychiatric illness. Diabetic ketoacidosis during the delivery hospitalization was associated with an increased risk of nontransfusion SMM (20.8% vs 2.4%, adjusted odds ratio [aOR] 8.18, 95% CI, 7.20-9.29), critical care procedures (7.3% vs 0.4%, aOR 15.83, 95% CI, 12.59-19.90), cardiac complications (7.8% vs 0.8%, aOR 8.87, 95% CI, 7.32-10.76), acute renal failure (12.3% vs 0.7%, aOR 9.78, 95% CI, 8.16-11.72), and transfusion (6.2% vs 2.2%, aOR 2.27, 95% CI, 1.87-2.75), as well as preterm birth (31.9% vs 13.5%, aOR 2.41, 95% CI, 2.17-2.69) and hypertensive disorders of pregnancy (37.4% vs 28.1%, aOR 1.11, 95% CI, 1.00-1.23). In secondary analyses, the overall frequency of antepartum DKA was 3.1%, and the mean annual percentage change was 4.1% (95% CI, 0.3-8.6%); the overall frequency of postpartum DKA was 0.4%, and the mean annual percentage change was 3.5% (95% CI, -1.6% to 9.6%). Of 3,092 antepartum hospitalizations among individuals with DKA, 15.7% (n=485) had a recurrent case of DKA at delivery hospitalization. Of 1,419 postpartum hospitalizations among individuals with DKA, 20.0% (n=285) previously had DKA at delivery hospitalization. The above risk factors for DKA at delivery hospitalization were similar for DKA at antepartum and postpartum hospitalizations. The frequency of DKA at delivery hospitalization and antepartum hospitalizations for DKA increased between 2010 and 2020 among deliveries in individuals with pregestational diabetes in the United States. Diabetic ketoacidosis is associated with an increased risk of maternal morbidity and adverse pregnancy outcomes. Risk factors for DKA at delivery were similar to those for DKA during the antepartum and postpartum periods.

Integration of Chronological Age Does Not Improve the Performance of a Mixed-Effect Model Using Comorbidity Burden and Frailty to Predict 90-Day Readmission After Surgery for Degenerative Scoliosis

ObjectiveWe evaluated the contributions of chronological age, comorbidity burden, and/or frailty in predicting 90-day readmission in patients undergoing degenerative scoliosis surgery. MethodsPatients were identified through the Healthcare Cost and Utilization Project Nationwide Readmissions Database. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty-defining indicator. Comorbidity was assessed using the Elixhauser Comorbidity Index (ECI). Generalized linear mixed-effects models were created to predict readmission using age, frailty, and/or ECI. Area under the curve (AUC) were compared using DeLong's test. Results8,104 patients were identified. Readmission rate was 9.8%, with infection representing the most common cause (3.5%). Our first model utilized chronological age, ECI, and/or frailty as primary predictors. The combination of ECI+frailty+age performed best, but the inclusion of chronological age did not significantly improve performance compared to ECI+frailty alone (AUC 0.603 vs. 0.599, p=0.290). A second model using only chronological age and frailty as primary predictors performed better, however the inclusion of chronological age worsened performance when compared to frailty alone (AUC 0.747 vs. 0.743, p=0.043). ConclusionsThese data support frailty as a predictor of 90-day readmission within a nationally representative sample. Frailty alone performed better than combinations of ECI and age. Interestingly, the integration of chronological age did not dramatically improve the model’s performance. Limitations include the use of a national registry and a single frailty index. This provides impetus to explore biological age, rather than chronological age, as a potential tool for surgical risk assessment.

The Influence of Modifiable Risk Factors on Postoperative Outcomes in Patients Receiving Surgery for Resection for Acoustic Neuroma.

Acoustic neuromas are the most common tumor of the cerebellopontine angle that are associated with a number of symptoms that negatively impact a patient's quality of life. While the mainstay of treatment for these benign tumors remains microsurgical resection, there is limited research exploring how certain modifiable risk factors (MRFs) may affect the perioperative course. The purpose of this study was to investigate how MRFs including malnutrition, obesity, dyslipidemia, uncontrolled hypertension, and smoking may affect postoperative rates of readmission and nonroutine discharges. We utilized the 2016 and 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database. MRFs were queried using appropriate International Classification of Diseases, Tenth Revision (ICD-10) coding for categories including malnutrition, obesity, dyslipidemia, smoking, alcohol, and hypertension. The statistical analysis was done using RStudio (Version 1.3.959). Chi-squared tests were done to evaluate differences between categorical variables. The Mann-Whitney U-testing was utilized to evaluate for statistically significant differences in continuous data. The "Epitools" package was used to develop logistic regression models for postoperative complications and post hoc receiver operating characteristic curves were developed. Pertaining to nonroutine discharge, predictive models using malnutrition outperformed all other MRFs as well as those with no MRFs (P < .05). In the case of readmission, models using malnutrition outperformed those of obesity and smoking (P < .05). Again, an increase in predictive power is seen in models using dyslipidemia when compared to obesity, smoking, or uncontrolled hypertension. Lastly, models using no MRFs outperformed those of obesity, smoking, and uncontrolled hypertension (P < .05). This is the first study of its kind to evaluate the role of MRFs in those undergoing surgical resection of their acoustic neuroma. We concluded that certain MRFs may play a role in complicating a patient's perioperative surgical course.

Invasive Pulmonary Aspergillosis in Hospitalized Hematopoietic Stem Cell Transplantation Recipients: Outcomes Based on the United States National Readmission Database.

Hematopoietic stem cell transplant (HSCT) is a well-established treatment for hematologic malignancies and certain autoimmune and congenital conditions. HSCT is associated with immunocompromise and increased risk of infections. This study assessed whether invasive pulmonary aspergillosis (IPA) affects in-hospital mortality and 30-day readmission among HSCT patients. A secondary objective was to examine potential differences in complications between HSCT with and without IPA. A retrospective study of a nationally representative cohort of hospital admissions was conducted, with data collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database between 2013 and 2019. The International Classification of Diseases, 10th revision (ICD-10), and 9th revision (ICD-9) diagnostic codes were used to identify patients with IPA and HSCT. All adult patients ≥18 years were included in the study. There were 90,451 hospitalizations for HSCT from 2013 to 2019; 89,331 (98.8%) had HSCT without IPA, while 1092 (1.2%) hospitalizations had HSCT with IPA. The in-hospital mortality for HSCT-IPA was higher compared to HSCT without IPA (18.3% vs. 4.2%; p < 0.001). HSCT-IPA had a significantly higher 30-day readmission rate (36.2%) than that of HSCT without IPA (24.0%). HSCT-IPA also had a higher mean cost of admission ($303,437) than that of HSCT without IPA ($57,587).The HSCT-IPA group had higher multi-organ complications, including respiratory failure (51.3% vs. 13.5%, p < 0.001), sepsis (38.2% vs. 18.5%, p < 0.001), septic shock (16.1% vs. 5.1%, p < 0.001), need for mechanical ventilation (21.1% vs. 5.1% p < 0.001), non-invasive positive pressure ventilation (4.9% vs. 2.5%, p < 0.001), and intensive-care unit admission (21.8% vs. 6.1% p < 0.001). IPA is a rare but severe complication associated with HSCT, with higher in-hospital mortality, complications due to multi-organ failure, readmission rates, and cost of hospitalization when compared to HSCT without IPA.

Association Between Mental Health Conditions at the Hospitalization for Birth and Postpartum Hospital Readmission.

Background: The relationship between physical comorbidities and postpartum hospital readmission is well studied, with less research regarding the impact of mental health conditions on postpartum readmission. Methods: Using hospital discharge data (2016-2019) from the Hospital Cost and Utilization Project Nationwide Readmissions Database (n = 12,222,654 weighted), we evaluated the impact of mental health conditions (0, 1, 2, and ≥3), as well as five individual conditions (anxiety, depressive, bipolar, schizophrenic, and traumatic/stress-related conditions) on readmission within 42 days, 1-7 days ("early"), and 8-42 days ("late") of hospitalization for birth. Results: In adjusted analyses, the rate of 42-day readmission was 2.2 times higher for individuals with ≥3 mental health conditions compared to those with none (3.38% vs. 1.56%; p < 0.001), 50% higher among individuals with 2 mental health conditions (2.33%; p < 0.001), and 40% higher among individuals with 1 mental health condition (2.17%; p < 0.001). We found increased adjusted risk of 42-day readmission for individuals with anxiety (1.98% vs. 1.59%; p < 0.001), bipolar (2.38% vs. 1.60%; p < 0.001), depressive (1.93% vs. 1.60%; p < 0.001), schizophrenic (4.00% vs. 1.61%; p < 0.001), and traumatic/stress-related conditions (2.21% vs. 1.61%; p < 0.001), relative to individuals without the respective condition. Mental health conditions had larger impacts on late (8-42 day) relative to early (1-7 day) readmission. Conclusions: This study found strong relationships between mental health conditions during the hospitalization for birth and readmission within 42 days. Efforts to reduce the high rates of adverse perinatal outcomes in the United States should continue to address the impact of mental health conditions during pregnancy and throughout the postpartum period.

Longer hospitalizations, more complications, and greater readmissions for patients with comorbid psychiatric disorders undergoing pulmonary lobectomy

ObjectiveTo examine the influence of comorbid psychiatric disorders (PSYD) on postoperative outcomes in patients undergoing pulmonary lobectomy. MethodsA retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2016 to 2018 was performed. Patients with lung cancer with and without psychiatric comorbidities who underwent pulmonary lobectomy were collated and analyzed (International Classification of Diseases, 10th Revision, Clinical Modification Mental, Behavioral and Neurodevelopmental disorders [F01-99]). The association of PSYD with complications, length of stay, and readmissions was assessed using a multivariable regression analysis. Additional subgroup analyses were performed. ResultsA total of 41,691 patients met inclusion criteria. Of these, 27.84% (11,605) of the patients had at least 1 PSYD. PSYD was associated with a significantly increased risk of postoperative complications (relative risk, 1.041; 95% CI, 1.015-1.068; P = .0018), pulmonary complications (relative risk, 1.125; 95% CI, 1.08-1.171; P < .0001), longer length of stay (PSYD mean, 6.79 days and non-PSYD mean, 5.68 days; P < .0001), higher 30-day readmission rate (9.2% vs 7.9%; P < .0001), and 90-day readmission rate (15.4% vs 12.9%; P < .007). Among patients with PSYD, those with cognitive disorders and psychotic disorders (eg, schizophrenia) appear to have the highest rates and risks of postoperative morbidity and in-hospital mortality. ConclusionsPatients with lung cancer with comorbid psychiatric disorders undergoing lobectomy experience worse postoperative outcomes with longer hospitalization, increased rates of overall and pulmonary complications, and greater readmissions suggesting potential opportunities for improved psychiatric care during the perioperative period.

Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion.

The "weekend effect" occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF. All ECSF patients > 18 years were retrospectively identified from the 2016-2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates. Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism. Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.

Abstract TMP103: Acute Ischemic Stroke Readmission In Patients With Periprocedural Atrial Fibrillation

Introduction: Anticoagulation therapy are commonly interrupted in patients with atrial fibrillation (AF) for elective procedures. However, risk factors of subsequent stroke during the periprocedural period is uncertain. We performed a nationwide analysis to evaluate risk factors for acute ischemic stroke (AIS) readmission in patients with AF admitted for elective procedure. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included electively admitted adult patients, who had AF diagnosis and procedural Diagnosis-related group code from 2016 to 2019. AF, AIS and other diagnosis were identified based on standard ICD-10 CM codes. Patients who had history of stroke or stroke during the index admission were excluded. We constructed a Cox regression model to determine hazard ratios (HR) of demographic, clinical factors and procedural type associated with AIS readmission. Results: Of the 1,048,422 patients with AF admitted for elective procedure, the mean age was 71.5 and 39.1% were female, and 1625 (0.15%) had AIS readmission within 30 days of discharge. In the adjusted Cox regression model, age (adjusted HR 1.05, 95% CI 1.04-1.06, P &lt; 0.001), female sex (aHR 1.22, 95% CI 1.05-1.41, P = 0.009), cancer (aHR 1.45, 95% CI 1.89-1.76, P &lt; 0.001), congestive heart failure (aHR 1.22, 95% CI 1.03-1.44, P = 0.021), diabetes (aHR 1.33, 95% CI 1.14-1.55, P &lt; 0.001), neurological surgery (aHR 2.27, 95% CI 1.69-3.06, P &lt; 0.001), cardiovascular surgery (aHR 1.59, 95% CI 1.32-1.91, P &lt; 0.001). Furthermore, higher CHADS 2 VASC 2 score (aHR 1.29 by one point, 95% CI 1.22-1.37, P &lt; 0.001) were associated with AIS readmission. Conclusion: AF patients with higher CHADS 2 VASC 2 score and those undergoing cardiac or neurological surgeries are at higher risk of perioperative stroke. Studies are needed to tailor anticoagulation management during the perioperative time to reduce perioperative AIS risk in such patients.

Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage.

Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization. Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines. Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4-6 weeks (P<0.001). In AIS, cancer, obesity, higher National Institutes of Health Stroke Scale (NIHSS) score, longer hospital stay, home or rehabilitation disposition, and absence of atrial fibrillation were associated with VTE readmission. In ICH, longer hospital stay and rehabilitation disposition were associated with VTE readmission. The VTE rate was higher in ICH compared to AIS (adjusted hazard ratio 2.86, 95% confidence interval 1.93-4.25, P<0.001). After stroke, VTE readmission risk is highest within the first 4-6 weeks and nearly three-fold higher after ICH vs. AIS. VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients.

Eclampsia and risk of postpartum readmission for cardiovascular disease in the first year after delivery

While the link between preeclampsia and cardiovascular disease (CVD) later in life has been well studied, there has been little focus on eclampsia as a risk factor, especially for short term outcomes. We determined the risk of postpartum readmission for CVD complications in the first year after delivery following a pregnancy complicated by eclampsia. We performed a retrospective cohort study of all singleton births in the United States from 2010-2018 using the Healthcare Cost and Utilization Project Nationwide Readmissions Database. Using ICD coding, we identified all readmissions for CVD complications during the first year after delivery in patients who had eclampsia. We calculated rates of CVD readmission (per 100,000 person-months of follow-up) and expressed associations between eclampsia and CVD rehospitalization based on confounder-adjusted hazard ratio (HR) with 95% confidence interval (CI). Of a total of 33,650,229 million delivery hospitalizations, 29,502 (90 per 100,000) pregnancies were complicated by eclampsia. The median follow-up among the eclampsia and normotensive groups were 5.8 and 4.5 months, respectively. The rate of CVD readmission among the eclampsia and normotensive groups were 1736.1 and 90.6 per 100,000 person-months, respectively (adjusted HR 18.04, 95% CI 16.73, 19.46) (Table). These HRs were high for specific coronary heart disease subtype (range 6.45 to 13.19). Eclampsia was associated with substantially high risk for stroke readmissions (HR 108.97, 95% CI 96.41, 123.17). Eclampsia leads to increased risk for morbidity from CVD complications even as early as the first year following delivery. These data highlight the need to identify patients with eclampsia for targeted short-term surveillance and follow up for CVD complications.

Differences According to Sex in Short-term Clinical Outcomes After Supraventricular Tachycardia Catheter Ablation: Insights from the Nationwide Readmission Database.

Catheter ablation is indicated for the management of supraventricular tachycardias (SVTs). We investigated the effect of sex on short-term outcomes after catheter ablation for SVTs other than atrial fibrillation (AF). Using the Healthcare Cost and Utilization Project Nationwide Readmission Database for the years 2016-2018, SVT patients who underwent catheter ablation were identified using the appropriate International Classification of Diseases, 10th Revision, codes. The primary outcome was 30-day readmissions. Secondary outcomes included 30-day readmissions for SVT, postprocedural bleeding, acute myocardial infarction, transient ischemic attack, stroke, hemopericardium, cardiac tamponade, length of stay (LOS) in the hospital, and total hospital charges (in USD). Female sex was not associated with an increased risk of the primary outcome (P = .168) but was associated with a significantly decreased risk of postprocedural revascularization (P = .001), LOS (P = .003), and total hospital charges (P = .002). There were no significant differences in other secondary outcomes. Among patients admitted for catheter ablation for SVTs (other than AF), female sex was associated with decreased LOS and total hospital charges, which may be attributed to increased comorbidity rates in men and gender-based biases.

Diabetes associated with higher health care utilization and poor outcomes after COPD-related hospitalizations.

Readmissions after hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (COPD) have a high socioeconomic burden. Comorbidities such as diabetes increase the risk for hospital readmissions, but the impact of diabetes on hospital outcomes remains unknown. The aim of this study was to evaluate the effect of complicated or uncomplicated diabetes on outcomes and health care costs related to admissions and readmissions in patients 35 years and older with an index admission for COPD. This was a retrospective longitudinal data analysis. We analyzed data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database. We analyzed the 2012-2015 HCUP Nationwide Readmissions Database and used multivariable weighted regression analyses to adjust for confounding factors. Individuals with any chronic pulmonary disease other than COPD were excluded. Of 1,728,931 patients hospitalized for COPD, 522,020 (30.2%) had a diagnosis of diabetes. Risk of all-cause 30-day readmission was higher among patients with complicated diabetes (adjusted odds ratio [OR], 1.15; 95% CI, 1.11-1.18) and uncomplicated diabetes (adjusted OR, 1.10; 95% CI, 1.08-1.12) compared with patients without diabetes. Diabetes was associated with longer length of stay, higher rates of hospital complications during index hospitalizations and 30-day readmissions, and a higher health care cost. Although diabetes was not associated with higher hospital mortality, routine hospital discharges were less common and the need for home health care upon discharge was higher among those with diabetes. Patients hospitalized for COPD and coexisting diabetes have worse clinical outcomes and higher 30-day readmissions compared with patients hospitalized for COPD without diabetes. Optimizing medical therapies and targeted interventions for both diseases is needed to alleviate disease burden to individuals and to society.

Monitoring Length of Stay of Acute Myocardial Infarction Patients: A Times Series Analysis Using Statistical Process Control.

Given that length of stay (LOS) of acute myocardial infarction (AMI) patients has a significant impact on the utilization of hospital resources and the health status of communities, this study focused on how best to monitor LOS of AMI patients admitted to U.S. hospitals by employing statistical process control (SPC). Data were abstracted from the Healthcare Cost and Utilization Project Nationwide Readmissions Database between 2010 and 2016. A total of 1,491 patients were examined in the study. Patients who were admitted to nonfederal government (public) hospitals in metropolitan areas of at least 1 million residents with the primary diagnosis of AMI were abstracted. They were excluded if they developed AMI secondary to an interventional procedure or surgery, died during their index hospitalization, and were admitted and discharged on the same day. Patients were also excluded if they were discharged to short-term hospitals, nursing facilities, intermediate care facilities, home healthcare, or against medical advice. Individual moving range (I-MR) charts were used to monitor LOS of individual AMI patients in each subgroup from 2010 to 2016. The results showed I-MR charts could be used to indicate statistically out-of-control signals on LOS. Specifically, I-MR charts showed that LOS decreased between 2010 and 2016. LOS appeared to be longer at teaching hospitals compared to nonteaching hospitals and varied by gender. Female patients appeared to stay longer than male patients in the hospitals. The application of SPC and control charts can facilitate improved decision-making in healthcare organizations. This study shows the value of integrating control charts in administrative and medical decision-making processes. It may also help healthcare providers and managers achieve higher quality and lower cost of care.

1594P Outcome, mortality and 30-day readmission of pericardial effusion in cancer patients

A pericardial effusion (PE) with various inflammatory and non-inflammatory causes can range from an incidental finding to a life-threatening emergency such as a cardiac tamponade. In the literature, little is known about the outcomes of PE in cancer patients. The study's primary objective was to assess whether intervention in PE affects in-hospital mortality and 30-days readmission among cancer patients. A retrospective study of a nationally representative cohort of hospital admissions was conducted from January 1, 2016, to December 31, 2019. Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database. All adult patients ≥18 years admitted with primary diagnosis of pericardial effusion in cancer patients were included in the study. We used the International Classification of Diseases, 10th revision, diagnostic codes to identify variable. The type of cancer included in the study were Breast, Lung, pancreatic, bladder, renal, colorectal, lymphoma and acute leukemia. The patients were stratified as PE in cancer patients underwent intervention versus no intervention. A total of 37,430 index hospitalizations for PE in cancer patients were identified for the years 2016-2019 in the NRD with the 27,980 index hospitalizations for PE without intervention, and 9,450 index hospitalizations for PE with intervention. There was no difference in in-hospital mortality for PE with and without intervention (4.5% vs 4.4%; p 0.76). However, PE without intervention had a significantly higher 30-day readmission rate than PE with intervention (31% vs 4.2.0%; p <0.001). The PE with intervention group had higher multi-organ complications including cardiogenic shock (8.6% vs 5.5%; p-value <0.001), Acute Kidney Injury (AKI) (29% vs 24.0%; p-value <0.001), respiratory failure (25% vs 20%, p-value <0.001), pneumonia (15% vs 12.6%, p-value 0.004), atrial fibrillation (27% vs 23.8%, p-value<0.001). Survival rates were not different between patients who received intervention and those who did not, but 30-day readmission rates were significantly higher for patients who did not receive intervention. Cancer patients would benefit from PE intervention.

Abstract P324: Clinical Outcomes And 30-day Readmissions For Heart Failure With Preserved Ejection Fraction And Cardiorenal Syndrome: A Multicenter Database Analysis.

Background: Literature regarding cardiorenal syndrome (CRS) outcomes among heart failure with preserved ejection fraction (HFpEF) is limited. Objective: This study sought to characterize CRS patients' clinical outcomes and 30-day readmission rates with HFpEF. Methods: Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) from January 1, 2018, to November 30, 2019. We used the International Classification of Diseases, 10 th revision (ICD-10) diagnostic codes to identify encounters with CRS related to HFpEF. Results: Out of the 1,530,749 index HFpEF-CRS related hospitalizations (mean age 74.44±12.42years; 56.7%females), 1,295,302(82.1%) had CKD stage I-IV and 281,689(17.9%) had CKD stage V+. The CKD I-IV+ group had higher multi-organ complications including atrial fibrillation (AF) (33.7% vs 21.1%; p-value &lt;0.001), acute kidney injury (AKI) (53.2% vs 20.1%; p-value &lt;0.001), AKI requiring hemodialysis (53.2% vs 20.1%; p-value &lt;0.001), respiratory failure (36.2% vs 34%, p-value &lt;0.001), and ischemic stroke (2.21% vs 2%, p-value &lt;0.001). However, the all-cause mortality for CRS with CKD V+ was higher as compared to CRS with CKD I-IV (4.83% vs 4.39%; p &lt;0.001). HFpEF with CKD V+ had a significantly higher 30-day readmission rates compared to CKD I-IV subgroup (40.6% vs 15.8%; p-value &lt;0.001). The predominant etiologies associated with 30-day readmissions among CKD I-IV in comparison to CKD V+ include cardiopulmonary (54.2%vs48.8%), and infectious (10.7%vs11.3%) diseases. Conclusion: Among HFpEF-CRS hospital encounters, progression of CKD stages is associated with higher 30-day readmission rates and all-cause mortality. These factors are accountable for a substantially increased healthcare burden. These findings suggest that regardless of CKD stages, patients with CRS should be monitored vigilantly during hospital admissions to avoid life-threatening complications.

Outcomes of invasive pulmonary aspergillosis in hospitalized hematopoietic stem cell transplantation recipients: A National Readmission Database study.

e19051 Background: Hematopoietic Stem Cell Transplant (HSCT) is well established method of treatment for hematologic malignancies and certain autoimmune and congenital conditions. HSCT is associated with compromise in the host immune system and increases risk of various infection in these patients, such as Invasive Pulmonary Aspergillosis (IPA). Methods: A retrospective study of a nationally representative cohort of hospital admissions was conducted from January 1, 2013 to December 31, 2018. Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) between 2013 and 2018. We used the International Classification of Diseases, 10th revision (ICD–10), and 9th revision (ICD-9) diagnostic codes to identify patients with IPA and HSCT. All adult patients ≥18 years were included in the study. Our study's primary objective was to assess the relationship between IPA on in-hospital mortality and 30-day readmission among patients undergoing HSCT. A secondary objective was to examine potential differences in complications between HSCT with IPA and HSCT without IPA. The absolute yearly mortality and rate of IPA for HSCT patients from 2013 to 2018 were also calculated. We used survey statistics to calculate weighted analysis and compared with Pearson’s chi-square test for categorical variables and t-test for the continuous variables. We calculated the odds ratio and 95% confidence interval in multivariate logistic regression for association of mortality among patients with IPA adjusted for model 1 variables including age, sex, smoking status, insurance type, and comorbid conditions. All p-values were 2 sided, with a significance threshold of p &lt; 0.05. Results: A total of 90,451 index hospitalizations for HSCT were identified for the years 2013-2018 in the NRD with the 89,331 index hospitalizations for HSCT without IPA, and 1,092 index hospitalizations for HSCT-IPA. The in-hospital mortality for HSCT-IPA was higher as compared to HSCT without IPA (18.3% vs 4.2%; p &lt; 0.001). HSCT-IPA had a significantly higher 30-day readmission rate (36.2%) than HSCT without IPA (24.0%). The HSCT-IPA group had higher multi-organ complications including atrial fibrillation (AF) (13.6% vs 8.3%; p &lt; 0.007), acute kidney injury (AKI) (54.8% vs 22.0%; p &lt; 0.001), respiratory failure (51.3% vs 13.5%, p &lt; 0.001), pneumonia (65.4% vs 19.4%, p &lt; 0.001), sepsis (38.2% vs 18.5%, p-value &lt; 0.001), septic shock (16.1% vs 5.1%, p &lt; 0.001), need for mechanical ventilation (21.1% vs 5.1% p &lt; 0.001), non-invasive positive pressure ventilation (4.9% vs 2.5%, p &lt; 0.001), and intensive-care unit admission (21.8% vs 6.1% p &lt; 0.001). Conclusions: IPA is rare but fatal complication associated with HSCT with higher in-hospital mortality, 30-day readmission, and complications due to multiorgan failure.

The Impact Of Acute Heart Failure Related Length Of Stay On The 30-day All-Cause Readmission Rate.

The Impact Of Acute Heart Failure Related Length Of Stay On The 30-day All-Cause Readmission Rate.

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery.

Retrospective cohort study of 2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD). The aim was to evaluate cost and outcomes associated with navigation use on posterior cervical fusion (PCF) surgery patients. Computer-assisted navigation systems demonstrate comparable outcomes with hardware placement and procedural speed compared with traditional techniques. Innovations in technology continue to improve surgeons' performance in complicated procedures, causing need to analyze the impact on patient care. The 2016 NRD was queried for patients with PCF surgery ICD-10 codes. Cost and readmission rates were compared with and without navigation. Nonelective cases and patients below 18 years of age were excluded. Univariate analysis on demographics, surgical data, and total charges was performed. Lastly, multivariate analysis was performed to assess navigation's impact on cost and postoperative outcomes. A total of 11,834 patients were identified, with 137 (1.2%) patients undergoing surgery with navigation and 11,697 (98.8%) patients without. Average total charge was $131,939.47 and $141,270.1 for the non-navigation and navigation cohorts, respectively ( P =0.349). Thirty-day and 90-day readmission rates were not significantly lower in patients who received navigation versus those that did not ( P =0.087). This remained insignificant after adjusting for several variables, age above 65, sex, medicare status, mental health history, and comorbidities. The model adjusting for demographic and comorbidities maintained insignificant results of navigation being associated with decreased 30-day and 90-day readmissions ( P =0.079). Navigation use in PCF surgery was not associated with increased cost, and patients operated on with navigation did not significantly have increased routine discharge or decreased 90-day readmission. As a result, future studies must continue to evaluate the cost-benefit of navigation use for cervical fusion surgery. Level III.

Abstract WP115: Venous Thromboembolism Readmission In Acute Ischemic Stroke

Introduction: Venous thromboembolism (VTE) is a frequent and potentially life-threatening complication of acute ischemic stroke (AIS). We performed a nationwide analysis to evaluate rate and risk factors for VTE readmission in patients with AIS. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included adult patients with a principal discharge diagnosis of AIS from 2016 to 2018. AIS, pulmonary embolism, deep vein thrombosis and other diagnosis were identified based on standard ICD-10 CM codes. Patients who had VTE diagnosis during the index admission were excluded. We determined 90-day VTE readmission rates and trends in patients with a principal diagnosis of AIS stratified by 30-day epochs. We then constructed a stepwise binary logistic regression model to determine odds ratios (OR) of demographic and clinical factors associated with VTE readmission rates. Results: Of the 1,023,478 patients with AIS, 8378 (0.82%) had VTE during readmission and 2906 (0.28%) had VTE as principal diagnosis for readmission within 90 days of discharge. Among them, more than half (4557, 54.39% and 1581, 54.40%, respectively) of patients were readmitted within 30 days of discharge. The rate of VTE readmission decreased further away from index event (P &lt; 0.001). In the Cox regression model, obesity (OR 1.48, 95% CI 1.24-1.76, P &lt; 0.001), plegia of at least one limb (OR 1.24, 95% CI 1.08-1.43, P = 0.003), longer hospital length of stay (OR 1.02, 95% CI 1.01-1.02, P &lt; 0.001), higher NIHSS (OR 1.04, 95% CI 1.03-1.05, P &lt; 0.001) were associated with VTE readmission. Conversely, VTE readmission rates were lower in patients with a history of atrial fibrillation/flutter (OR 0.72, 95% CI 0.62-0.84, P &lt; 0.001). Conclusion: Patients with obesity, paralysis, higher NIHSS score, or prolonged hospital length of stay are at higher risk for VTE readmission. AF strokes are less likely to have DVT/PE, perhaps due to anticoagulant use in such patients. Studies are needed to determine whether early mobilization and mechanical and/or chemical prophylaxis reduces VTE risk in high-risk patients.

Abstract TP215: Principal Hospital Admission Of Hypertension Foreshadows 3-month Ischemic And Hemorrhagic Stroke

Introduction: Hypertension is a well-recognized risk factor for acute ischemic stroke (AIS) and intraparenchymal hemorrhagic (IPH). We performed a nationwide analysis to evaluate the rate of AIS and IPH readmission comparing patients with hypertension as a principal versus non-principal diagnosis. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with index admission diagnosis (principal or non-principal) of hypertension from 2016 to 2018. Hypertension, AIS, IPH, and other diagnoses were identified based on standard ICD-10 CM codes. Patients with AIS or IPH diagnoses during the index admission were excluded. We determined post-discharge 90-day admission trends by Kaplan-Meier estimates in patients with principal versus non-principal diagnosis of hypertension. We then constructed Cox regression models to determine associations between principal diagnosis of hypertension and AIS or IPH admission rates, with adjustment to age, gender, insurance type, zip code income quartile, index admission disposition, and Elixhauser comorbidities. Results: Of the 36,173,682 patients identified, 586,613 (1.62%) had a principal diagnosis of hypertension during the index admission. Patients with a principal diagnosis of hypertension were more likely to have an AIS or IPH during 90-day follow up versus non-principal diagnosis of hypertension (Figure). In the Cox regression model after the aforementioned adjustments, a principal diagnosis of hypertension was significantly associated with AIS (HR 2.37, 95% CI 2.23-2.53, P &lt; 0.001) and IPH admission (HR 2.25, 95% CI 1.97-2.56, P &lt; 0.001). Conclusion: Patients with hypertensive conditions warranting hospitalization as principal diagnosis are at increased risk of AIS and IPH in the first 90-days after discharge. Post-discharge planning should include intensive ambulatory blood pressure monitoring and control by outpatient providers.