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Background

Decreasing hospital readmissions has become a national priority and a measure of quality of care. Little is known about readmissions among ulcerative colitis (UC) patients on a national level. The aim of this study was to describe unplanned hospital readmission rates among adult UC patients and assess predictors of readmission.

Methods

We analyzed the 2013 National Readmission Database (NRD) to quantify readmission rates among UC patients. The NRD includes weighted discharge data from 21 geographically diverse states accounting for 49.3% of the U.S. population. It includes approximately 14 million un-weighted discharges (49.1% of all U.S. discharges) corresponding to 36 million annual discharges nationwide. NRD data is from patients with non-Medicare payers (Medicaid, private, self-pay, or other). UC hospitalizations were identified using the International Classification of Diseases, ninth Revisions, Clinical Modification (ICD-9-CM) diagnosis code 556.x. All hospitalizations for patients age ≥18 and <80 years (to limit inclusion of ischemic colitis) were included. Exclusion criteria included ICD-9-CM for Crohn's disease, pregnancy, admissions for chemotherapy, death during index hospitalization, elective admissions, length of stay (LOS) <24 hours, and missing data on disposition or LOS. The primary outcome was 30-days unplanned readmission rate and secondary outcomes included variables associated with risk of 30-days readmission. Admissions were stratified as having UC as a primary or secondary discharge diagnosis. We utilized Chi-square tests, t tests and Wilcoxon rank-sum tests as appropriate. Survey logistic regression assessed factors associated with readmission controlling for patient demographics, comorbidities, hospital characteristics, payer type, and the all patient refined diagnoses related group (APR-DRG) severity scale which categorizes patient loss of function status.

Results

A total of 75,093 index hospitalizations were included in the analysis of which 26,094 had UC as the primary diagnosis. Among those with a primary UC diagnosis, there were 2757 30-days readmissions (10.6%). There were 3419 readmissions (7.0%) among those with UC as a secondary diagnosis on index hospitalization. Fifty-eight percent of patients with UC as the primary diagnosis on index hospitalization were readmitted with the same diagnosis. The next most common readmission diagnoses were complications of surgical procedures or medical care (5.5%), Clostridium difficile (4.8%), and septicemia (4.3%). In multivariable analysis of index hospitalizations with UC as the primary diagnosis, LOS ≥7 days (OR 1.54, 95% CI, 1.24–1.90), not having an endoscopy (OR 1.20, 95% CI, 1.04–1.38), and depression (OR 1.37, 95% CI, 1.16–1.66) were significantly associated with 30-days readmission after adjusting for demographics, comorbidities, hospital characteristics, payer type, and the APR-DRG severity scale. Having a colectomy did not significantly increase the risk of readmission (OR 1.14, 95% CI, 0.86–1.52).

Conclusions

In a national readmissions database, 10.6% of patients admitted with a primary diagnosis of UC were readmitted within 30 days. Significant predictors of readmission included LOS ≥7 days, not having an endoscopy on index hospitalization, and depression.

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Copyright © 2017 Crohn's & Colitis Foundation of America, Inc.
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