Risk factors for hospital readmission following complicated urinary tract infection

ObjectiveIn this investigation, we aimed to explore risk factors for 90-day hospital readmission among patients with cirrhosis and ascites in an Asian population.MethodsIn this retrospective study, we included consecutive patients diagnosed with cirrhosis and ascites hospitalized in Renji Hospital between 2018 and 2022 to elucidate risk factors for 90-day readmission. We conducted multivariate logistic regression analysis to identify readmission risk factors.ResultsWe included 265 patients with cirrhosis and ascites. A 43% readmission rate was observed within 90 days. After adjustment for multiple covariates, we found that readmission within 90 days was independently linked to reduced levels of hemoglobin (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.97) and serum albumin (OR 0.88, 95% CI 0.83–0.93), and higher Model for End-Stage Liver Disease and sodium (MELD-Na) scores (OR 1.04, 95% CI 1.01–1.07) at discharge.ConclusionsPatients with cirrhosis who have ascites are frequently rehospitalized within 90 days after discharge. Lower hemoglobin or albumin and higher MELD-Na scores at discharge may be the main risk factors for hospital readmission.

Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease

A prediction model for 30-day readmission in patients with acute pancreatitis (AP) was needed. To develop a nomogram to predict 30-day readmission in patients with AP and validate the usefulness of serum indicators after discharge for the prediction of 30-day readmission. This was a retrospective cohort study enrolling patients with the first attack of AP. Baseline characteristics, clinical profiles, and serum indicators after discharge were compared. Multivariate logistic regression analysis and a nomogram were employed to determine the independent risk factors for 30-day readmission. A total of 7.32% (121/1653) of the patients were readmitted within 30days after discharge. Different etiologies (biliary pancreatitis (adjusted odds ratio (AdjOR), 9.63; 95% confidence interval (CI), 1.28-72.52; P = 0.028), other causes (AdjOR, 9.37; 95% CI, 1.15-76.12, P = 0.026), mixed causes (AdjOR, 10.76; 95% CI, 1.27-91.35; P = 0.03) compared with alcoholic pancreatitis)), infected pancreatitis necrosis (IPN) (AdjOR, 2.3; 95% CI, 1.2-4.42; P = 0.013), total bilirubin level ≥ 20.5µmol/L (AdjOR, 2.42; 95% CI, 1.23-4.77; P = 0.01), glucose level ≥ 6.1mmol/L (AdjOR, 1.93; 95% CI, 1.16-3.19; P = 0.011), and albumin level < 40g/L (AdjOR, 4.25; 95% CI, 2.44-7.41; P < 0.001) were independently associated with 30-day readmission. A nomogram incorporating these factors demonstrated good discrimination, calibration, and clinical utility. Serum indicators after discharge added predictive value compared with clinical variables alone (AUC, 0.78 vs. 0.685; P = 0.0001). The nomogram combining etiology, IPN, and serum indicators after discharge has favorable predictive performance for 30-Day readmission. The close monitoring and reexamination of serum indicators are essential for AP patients at high risk.

Hospital readmission is gathering greater attention as a measure of health care quality. The introduction of fast-track surgery has led to shorter lengths of hospitalization without increasing the risk of postoperative complications and readmission. The collection of comprehensive readmission data is essential for the further improvement of patient care. The aim of the present study is to evaluate the risk factors for readmission within 30days of discharge after gastrectomy. A total of 1929 patients who underwent radical gastrectomy at Shizuoka Cancer Center were included in this study. A risk analysis with a stepwise logistic regression model was conducted to identify the risk factors for 30-day hospital readmission. The 30-day readmission rate was 2.70%. Common causes of readmission were an intolerance of oral intake and the presence of an intra-abdominal abscess. The C reactive protein (CRP) level on postoperative day (POD) 3 was significantly higher in the readmitted group; however, the other surgical outcomes, including the incidence of postoperative complications, did not differ to a statistically significant extent. The stepwise logistic regression analysis revealed that CRP on POD3 ≥ 12mg/dl [odds ratio (OR) 2.08, 95% confidence interval (CI) 1.09-3.95, p = 0.025], laparoscopic surgery (OR 2.25, 95% CI 1.17-4.31, p = 0.015), and TG (OR 2.23, 95% CI 1.17-4.78, p = 0.023) were found to be independent risk factors for readmission. CRP on POD3 ≥ 12mg/dl, laparoscopic surgery, and TG were identified as independent risk factors for readmission.

Objective. Early readmission rates are becoming an integral measure of the quality of care for hospitalized patients with chronic diseases. The incidence and predictors of early readmission in patients with inflammatory bowel disease (IBD) are uncertain. Risk factors for readmission over the first few weeks may differ from those that influence re-hospitalization at later time points. We examined the incidence and predictors of both 30-day and 90-day readmissions among ulcerative colitis (UC) patients. Materials and methods. A retrospective, cohort study was performed including all severe UC patients admitted to a tertiary-care hospital between January 2007 and December 2011. All-cause readmissions to the medical or surgical service within 30 and 90 days were recorded to allow the calculation of early readmission rates. We used multiple logistic regression to analyze demographic, hospital-related, general medical and IBD-specific factors as potential risk factors for readmission. Results. There were a total of 229 patients discharged following hospitalization for severe UC. The 30- and 90-day readmission rates were 11.7% and 20.5%, respectively. Forty-seven percent of early readmissions were for colectomy. In the 30-day analysis, only the presence of extensive colitis (odds ratio 3.59; 95% confidence interval [CI] 1.41–9.13) compared with left-sided disease was independently associated with readmission. Extensive colitis (3.09, 95% CI 1.33–7.08), albumin on admission (0.56, 0.31–0.99) and being admitted to a housestaff service (2.87, 95% CI 1.14–6.54), were independent predictors of readmission at 90 days. Conclusions. Early readmission is common in IBD. Independent risk factors for early readmission included extensive colitis, admission albumin, and being admitted to a housestaff service.

Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management. To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia. Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U.S. Adults ≥18years of age with diabetes, discharged from a hospital between January 1, 2009, and December 31, 2014 (N=342,186). Principal diagnoses and risk factors for 30-day unplanned readmissions, subset as being for severe dysglycemia vs. all other causes. We analyzed 594,146 index hospitalizations among adults with diabetes: mean age 68.2years (SD, 13.0), 52.9% female, and 67.8% white. The all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for index hospitalization (5.5%) and readmission (8.9%). Severe dysglycemia accounted for 2.6% of index hospitalizations (48.1% hyperglycemia, 50.4% hypoglycemia, 1.5% unspecified) and 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger patient age, severe dysglycemia at index or prior hospitalization, and the Diabetes Complications Severity Index (DCSI) were the strongest risk factors predisposing patients to severe dysglycemia vs. other readmissions. Prior episodes of severe dysglycemia and the DCSI were also independent risk factors for other-cause readmissions, irrespective of the cause of the index hospitalization. Adults with diabetes are hospitalized and readmitted for a wide range of health conditions, and hospitalizations for severe hypoglycemia and hyperglycemia remain common, with high rates of recurrence. Severe dysglycemia is most likely to occur among younger patients with multiple diabetes complications and prior history of such events.

INTRODUCTION: Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory bowel diseases (IBD), with frequent hospital admission. Biologics have become the mainstay of therapy in patients with moderate and severe UC. Due to lack of contemporary readmission data since the advent of biologics, we decided to conduct a nationwide readmission study (NRD) on national United States (US) data, to identify the risk factors for 30-day readmission in UC patients after an index admission. METHODS: In this retrospective cohort study, we utilized Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Nationwide Readmission Database (NRD) for the year 2016 and 2017. In United States, NRD is the largest publicly available all-payer inpatient health care readmission database. We used the ICD10-CM diagnosis code K51.x to identify all adult patients with UC. RESULTS: There were 71,500,000 hospitalizations in 2016-2017 in the United States, 54,138 index admissions had UC as the primary diagnosis whereas 93,192 admission had UC as secondary diagnosis (Figure 1). The 30-day non-elective readmission rate after an index admission with a primary UC diagnosis was 13.2%. We used multivariate logistic regression to identify independent predictors of 30-day readmission. Age< 65, men, longer LOS, higher APR-DRG severity, pulmonary embolism, malnourished, electrolyte imbalance, anemic, anxious, alcohol use and bowel surgery. The variables that were associated with lower odds of 30-day readmission were older age, lower endoscopy, and marijuana use (Table 1). The rest of the variables had no influence on 30-day readmission. CONCLUSION: Our study identified the predictors of 30-day readmission associated with UC in the United States. This calls for a greater recognition of these risk factors and amelioration of its risk-factors, to prevent readmission and decrease mortality, whenever possible.Figure 1.: Flowsheet of the cohort of study population. Unweighted number of patients (weighted number). UC, Ulcerative colitis.Table 1.: Multivariate logistic regression analysis to identify independent risk factors for 30-day readmission in patients with Ulcerative ColitisTable 2.: Multivariate logistic regression analysis to identify independent risk factors for 30-day readmission in patients with Ulcerative Colitis

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) programs have shown to reduce hospital readmissions; however, 20-25% of OPAT patients are readmitted. As 30-day readmissions is a healthcare quality measure, it is important to recognize predictors for readmissions in OPAT patients in an effort to minimize risk factors and optimize patient outcomes. The aim of this study was to identify modifiable and non-modifiable risk factors for 30-day unplanned readmission in patients discharged with OPAT.MethodsThis was a retrospective cohort study of patients admitted to University of Virginia (UVA) Health System between March 2019 and December 2019 who were discharged home with intravenous antimicrobials followed by the UVA OPAT program. Data collected included patient demographics, comorbidities, infection diagnosis, source control, and antimicrobial class. Variables were compared between patients with a 30-day unplanned readmission and those without a readmission. Mann-Whitney U, Pearson chi-squared, and Fisher’s exact tests were utilized, as appropriate. A multiple logistic regression analysis was performed to determine predictors of 30-day unplanned readmission.ResultsThere were 334 OPAT patients who met inclusion criteria. Median age was 58 years, 58% were male, and the most common infection diagnoses were bone/joint (49%), bloodstream (22%), and endovascular (13%). There were 64 (19%) patients who had an unplanned 30-day readmission. The most common reasons for readmission included non-infection related (45%), worsening infection (28%), and antimicrobial-related complication (17%). Readmitted patients were more likely to have a higher Charlson Comorbidity Index (CCI); prior admissions; bloodstream, endovascular, or pulmonary infection; no source control; and an infection caused by a multi-drug resistant organism. CCI was found to be an independent predictor of readmission (OR 1.096, 95% CI 1.001-1.200).ConclusionUnplanned readmissions were common in patients discharged with OPAT. There should be an emphasis on interventions to prevent readmissions in OPAT patients, particularly those with high-risk clinical characteristics.DisclosuresAll Authors: No reported disclosures

The Child with Multiple Injuries

Sex differences in rates and causes of 30-day readmissions after cardiac electronic device implantations: insights from the Nationwide Readmissions Database

Background Vancomycin is the standard of care for Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), but daptomycin is increasingly being used. There are few real-world outcome comparisons.Table 1:Clinical Characteristics of Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infection Discharged on OPAT Table 1 summarizes patient demographic data, comorbidities, characteristics of index admission, and type of infection at index admission.Table 2:Factors Associated with 90-day Same-Infection Readmission in Multivariate Analysis Table 2 outlines results of logistic regression analysis used to investigate risk factors for same-infection 90-day readmission. Methods In this retrospective cohort study, adults with MRSA BSI were queried using the insurance-claim-derived Merative MarketScan® database (2013–2022). Logistic regression was used to investigate risk factors for all-cause readmission as well as 90-day hospital readmission with the same infection among patients discharged on vancomycin compared to daptomycin. Kaplan-Meier curves visually summarized differences in time to readmission.FIgure 1:(1) Adjusted Odds Ratios for Factors Associated with 90-day Same-Infection Readmission and (B) Same-Infection Readmission-Free Survival in Patients Discharged on Vancomycin versus Daptomycin Figure 1A is a Forest Plot illustrating results from univariate and multivariate analyses used to identify factors associated with 90-day same-infection readmission (red indicates multivariate analysis, blue indicates univariate analysis) . Figure 1B is a Kaplan-Meier survival curve demonstrating 90-day same-infection readmission-free survival in patients discharged on vancomycin (blue) versus daptomycin (red). Results Among 2,743 patients with MRSA BSI, 668 were discharged on Vancomycin and 570 on Daptomycin. Baseline characteristics were similar (Table 1). Readmissions with the same infection/s (primary endpoint, 14.4% vs. 10.9%, p=0.08) and all-cause readmissions were comparable (daptomycin 35.9% vs. vancomycin 38.5%, p=0.40), (Table 2). In adjusted multivariable models, heart failure (aOR, 2.03 [95% CI, 1.18-3.50]), brain abscesses (aOR, 2.06 [95% CI, 1.16-3.67]), and osteomyelitis (aOR, 1.45 [95% CI, 0.98-2.15]) were all associated with increased risk of 90-day readmission from same infection (Figure 1A), while daptomycin use was not (aOR, 1.32 [95% CI, 0.93-1.85]) . Readmission free survival was comparable between groups through day 15 (log rank test, p=0.11, Figure 1B). Conclusion Patients with MRSA BSI discharged on daptomycin had similar 90-day readmission outcomes as those discharged on vancomycin. There was a trend towards increased risk of readmissions with daptomycin after day 15 for the same infection which needs further investigation. Despite treatment advances, MRSA BSI readmission rates remain high and are influenced by infection complexity and comorbidities. Disclosures All Authors: No reported disclosures

Exploring Entrustment: Housestaff Autonomy and Patient Readmission

Objectives: Stroke is a non-communicable chronic disease (NCDs) increasingly prevalent in the world population and one of the main causes of mortality in Brazil. Hospital readmission rates after acute stroke have been used to measure performance of the health system in managing the disease. Studies have shown that readmission rates within 30 days vary from 6.5% to 29% among countries. However, most readmission studies were carried out in developed countries while there is a lack of this type of studies in underdeveloped and developing countries. The present work aims to investigate the causes and factors associated with 30-day readmission in Brazilian stroke patients. Materials and Methods: A retrospective cohort study was carried out in a private hospital in Porto Alegre including stroke patients from 2016 to 2021, over 18 years old. Logistic regression was applied to assess factors associated with 30-day readmission. Results: A total of 474 patients were included in the study of which 51 (10.75%) were readmitted within thirty days. The most frequent causes for readmission were cerebrovascular events (33.3%) followed by infections (25.5%). Predictor variables for readmission were: use of mechanical ventilation, congestive heart failure (CHF), urinary tract infection (UTI), use of nasoenteric tube or gastrostomy (NET/G-tube), bronchopneumonia (BPN), deep vein thrombosis (DVT), atrial fibrillation, diabetes mellitus, smoking, obesity, pulmonary congestion, pulmonary embolism, moderate/severe National Institute of Health Stroke Scale (NIHSS) deficit, previous functional outcome classified as moderate/impaired at the time of admission, impaired functional outcome during index hospitalization and impaired functional outcome at hospital discharge. Conclusions: Investigation of causes and factors leading to 30-day readmission after a stroke is of great importance to improve care practices, policy decisions for health systems as well as personalized educational and treatment approaches. Several factors that may predict a higher risk of 30-day hospital readmission after a stroke have been identified. It has been verified that 10.75% of stroke patients were readmitted within thirty days after discharge, which is a value comparable with those found in the literature for developed countries hospitals.

Epidemiology and Predictors of 30-Day Readmission in Patients With Sepsis

Le volume annuel de cas est un facteur de risque pour la réadmission non programmée après 30 jours suivant l’ostéosynthèse des fractures de l’acetabulum