Early readmission in patients hospitalized for ulcerative colitis: incidence and risk factors

Background Prior studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBD). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors. Methods We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis (UC) or Crohn's disease (CD) and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidites during index admission. Logistic regression was used to estimate factors associated with hospital readmission. Results Among 52,498 hospitalizations of IBD patients (63% CD and 37% UC), 12,407 (24%) were readmitted within 90 days of the index hospitalization resulting in roughly $576 million in excess charges. In multivariable analysis of patients with CD, anxiety (OR 1.31, 95%CI:1.21–1.43), depression (OR 1.27, 95%CI:1.07–1.50), chronic pain (OR 1.31, 95%CI:1.18–1.46), and tobacco abuse (OR 1.13, 95%CI:1.06–1.22) were associated with a significant increase in odds of readmission. Among patients with UC, anxiety (OR 1.28, 95%CI:1.14–1.45), depression (OR 1.35, 95%CI:1.07–1.70), and chronic pain (OR 1.44, 95%CI:1.21–1.73) were associated with a significant increase in odds of readmission. Conclusions Readmission occurs frequently in patients with IBD, and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90 day hospital readmission in this population.

Section: Discussionmentioning

confidence: 50%

Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

Barnes

Kochar

Long

et al. 2017

“…The 30-day readmission rate in the NRD was similar to the findings from a retrospective study of severe UC patients admitted to the Mount Sinai Medical Center between 2007 and 2011 which reported a 30-day all-cause readmission rate of 11.7%. 12 In this study, the only significant independent predictors of 30-day readmission were extensive colitis, albumin on admission, and admission to a housestaff service.…”

Section: Discussionmentioning

confidence: 56%

“…Most prior data on UC readmissions have been from single center experiences or other countries. 12–16 Therefore, we analyzed an all-payer, nationally representative database to describe unplanned 30-day readmissions and to assess predictors of readmission among adult UC patients in the United States.…”

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confidence: 99%

Predictors of Hospital Readmissions for Ulcerative Colitis in the United States

Poojary

Saha

Chauhan

et al. 2017

Self Cite

Background Early readmissions are important indicators of quality of care. Limited data exist describing hospital readmissions in ulcerative colitis (UC). The aim of this study was to describe unplanned, 30-day readmissions among adult UC patients and to assess readmission predictors. Methods We analyzed the 2013 United States National Readmission Database and identified UC admissions using administrative codes in patients from 18 to 80 years of age. Our primary outcome was a 30-day, unplanned readmission rate. We used chi-square tests, t tests, and Wilcoxon rank-sum tests for descriptive analyses and survey logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations with readmissions adjusting for confounders. Results Among 26,094 hospitalizations with a primary UC diagnosis, there were 2757 (10.6%) 30-day, unplanned readmissions. The most common readmission diagnoses were reasons related to UC (58%), complications of surgical procedures/medical care (5.5%), Clostridium difficile (4.8%), and septicemia (4.3%). In multivariable analysis, length of stay ≥7 days (aOR 1.54, 95% CI, 1.24–1.90), not having an endoscopy (aOR 1.20, 95% CI, 1.04–1.38), and depression (aOR 1.40, 95% CI, 1.16–1.66) were significantly associated with readmission. 58.2% of readmissions had at least one of these factors. Patients were also less likely to be admitted if they were women or had self-pay payer status. Having a colectomy did not significantly increase readmissions (aOR 1.14, 95% CI, 0.86–1.52). Conclusions On a national level, 1 in 10 hospitalizations for UC was followed by an unplanned readmission within 30 days. Not having an endoscopy on the index hospitalization and depression were independently associated with readmissions. Further studies should examine if strategies that address these predictors can decrease readmissions.

“…8 However, a recent study assessed 30-day and 90-day readmissions in UC patients and found that certain risk factors for 90-day readmission were in fact related to disease severity. 9 Several previous studies have investigated the relationship between IBD and psychiatric disease. There is evidence that both depression and anxiety are more common in IBD patients 10 and that both are likely undertreated.…”

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confidence: 99%

Risk Factors for Rehospitalization Within 90 Days in Patients with Inflammatory Bowel Disease

Allegretti

Borges

Lucci

et al. 2015

Background Care of patients with inflammatory bowel disease (IBD) poses a significant burden to the health-care system. Repeat hospitalization in subgroups of IBD patients seems to be a large part of this issue; however, there are limited data examining the characteristics of these patients. The aim of this study was to characterize admission patterns in patients with IBD at a tertiary-care center and to identify preventable risk factors of 90-day readmission after an index IBD admission. Methods Retrospective analysis was performed extracting data from an electronic medical record over a 2-year period. Results Three hundred fifty-six patients were admitted at least once during the 2-year study period for an unplanned IBD-related reason. Of these, 48.9% were admitted once, 38.2% were admitted 2 to 4 times, and 12.9% were admitted 5 or more times during the study period. Patients with any admission within 90 days before index were excluded; n = 33. One hundred two patients had experienced a readmission by 90 days after index admission. Numerous demographic and medical factors were examined for association with readmission. The final Cox model included 3 variables: depression (HR = 1.99, 1.33–3.00), chronic pain (HR = 1.88, 1.14–3.10), and steroid use in the previous 6 months (HR = 1.33, 0.92–2.04). Conclusions Our findings suggest that patients with depression and chronic pain are at greatest risk for a readmission within 90 days after an initial IBD admission. Disease activity, represented by steroid use in the previous 6 months, was not related to readmission. Addressing these problems in the outpatient setting may reduce future hospitalizations.