Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States

Abstract

Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.

Acute respiratory distress syndrome readmissions: A nationwide cross-sectional analysis of epidemiology and costs of care

“…Prior studies which utilized codes for acute hypoxemic respiratory failure to evaluate ARDS readmission risk found 30-day rates between 12–18% [ 6 , 7 ], similar to our findings. The readmission rate is higher than previously reported for pneumonia [ 8 ], but nearly identical to rates seen in heart failure and sepsis readmission studies [ 9 , 20 ].…”

“…Previous studies which have explored the epidemiology and risk factors associated with patients with ARDS requiring readmission within 30 days were performed prior to the existence of specific billing codes for ARDS [ 6 , 7 ]. The most closely associated conditions with ARDS, pneumonia and sepsis, have been previously assessed in nationwide databases, with 30-day readmission rates of 7.5% and 17.5% respectively [ 8 , 9 ].…”

Risk factors and prediction score model for unplanned readmission among neonates with NRDS under one year of age: A retrospective cohort study

“…Although there have been some studies that assessed the association of risk factors with readmission among patients with respiratory distress syndrome in adults (12)(13)(14), little attention has been given to unplanned readmission of NRDS in neonates. We found no report on unplanned readmission of NRDS in neonates at present, and the risk factors for readmission among neonates with NRDS remain unclear.…”