Predictors of Hospital Readmissions for Ulcerative Colitis in the United States

A National Database Study

Priti Poojary, Aparna Saha, Kinsuk Chauhan, Priya Simoes, Bruce E. Sands, Judy Cho, Thomas A. Ullman, Girish Nadkarni, Ryan Ungaro

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)347-356
Number of pages10
JournalInflammatory Bowel Diseases
Volume23
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Patient Readmission
Ulcerative Colitis
Databases
Confidence Intervals
Hospitalization
Nonparametric Statistics
Endoscopy
Clostridium difficile
Colectomy
Quality of Health Care
Chi-Square Distribution
Length of Stay
Sepsis
Logistic Models
Odds Ratio

Keywords

  • depression
  • hospitalization
  • inflammatory bowel disease
  • length of stay

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Predictors of Hospital Readmissions for Ulcerative Colitis in the United States : A National Database Study. / Poojary, Priti; Saha, Aparna; Chauhan, Kinsuk; Simoes, Priya; Sands, Bruce E.; Cho, Judy; Ullman, Thomas A.; Nadkarni, Girish; Ungaro, Ryan.

In: Inflammatory Bowel Diseases, Vol. 23, No. 3, 01.03.2017, p. 347-356.

Research output: Contribution to journalReview article

Poojary, P, Saha, A, Chauhan, K, Simoes, P, Sands, BE, Cho, J, Ullman, TA, Nadkarni, G & Ungaro, R 2017, 'Predictors of Hospital Readmissions for Ulcerative Colitis in the United States: A National Database Study', Inflammatory Bowel Diseases, vol. 23, no. 3, pp. 347-356. https://doi.org/10.1097/MIB.0000000000001041
Poojary, Priti ; Saha, Aparna ; Chauhan, Kinsuk ; Simoes, Priya ; Sands, Bruce E. ; Cho, Judy ; Ullman, Thomas A. ; Nadkarni, Girish ; Ungaro, Ryan. / Predictors of Hospital Readmissions for Ulcerative Colitis in the United States : A National Database Study. In: Inflammatory Bowel Diseases. 2017 ; Vol. 23, No. 3. pp. 347-356.
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abstract = "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.",
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N2 - 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.

AB - 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.

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