Incidence and risk factors for 30-day readmission in ulcerative colitis: nationwide analysis in biologic era.
Journal
European journal of gastroenterology & hepatology
ISSN: 1473-5687
Titre abrégé: Eur J Gastroenterol Hepatol
Pays: England
ID NLM: 9000874
Informations de publication
Date de publication:
01 09 2021
01 09 2021
Historique:
pubmed:
26
5
2021
medline:
28
9
2021
entrez:
25
5
2021
Statut:
ppublish
Résumé
Ulcerative colitis (UC) is a chronic relapsing and remitting disease requiring frequent hospitalization. Biologics have become the recommended initial therapy for Biologics in patients with moderate to severe UC. Our aim was to estimate the changes in Nationwide Healthcare utilization and assess predictive factors of 30-day readmission, morbidity and mortality of UC. This is a retrospective observational study analyzing the Nationwide Readmission database from 2016 to 2017 using ICD-10 codes. The primary outcomes of the study were to assess the predictors of 30-day readmission in patients with UC. Of the 54 138 adult patients with a primary diagnosis of UC, 13.2% were readmitted within 30 days of index hospitalization. The mortality rate (1.4 vs. 0.3%, P < 0.01), length of stay (7 vs. 4.9 days, P < 0.01) and hospital cost ($62 552 vs. $46 971, P < 0.01) were higher on readmission as compared to index hospitalization. We identified multiple patient-related factors (age <65years, men, VTE, protein calorie malnutrition, electrolyte imbalance, anemia, anxiety and alcohol abuse), hospital-related factors (teaching hospitals, high quintile hospitals), as independent predictors of 30-day UC readmission. Colonoscopy, Cannabis use, and colectomy were associated with decreased odds of 30-day readmission. The most common cause of UC was septicemia. This is the largest nationwide study demonstrating predictors of 30-day readmission, mortality and morbidity associated with UC. Identification and amelioration of these risk factors will decrease readmission rate and mortality amongst UC patients.
Sections du résumé
BACKGROUND AND STUDY AIM
Ulcerative colitis (UC) is a chronic relapsing and remitting disease requiring frequent hospitalization. Biologics have become the recommended initial therapy for Biologics in patients with moderate to severe UC. Our aim was to estimate the changes in Nationwide Healthcare utilization and assess predictive factors of 30-day readmission, morbidity and mortality of UC.
METHODS
This is a retrospective observational study analyzing the Nationwide Readmission database from 2016 to 2017 using ICD-10 codes. The primary outcomes of the study were to assess the predictors of 30-day readmission in patients with UC.
RESULTS
Of the 54 138 adult patients with a primary diagnosis of UC, 13.2% were readmitted within 30 days of index hospitalization. The mortality rate (1.4 vs. 0.3%, P < 0.01), length of stay (7 vs. 4.9 days, P < 0.01) and hospital cost ($62 552 vs. $46 971, P < 0.01) were higher on readmission as compared to index hospitalization. We identified multiple patient-related factors (age <65years, men, VTE, protein calorie malnutrition, electrolyte imbalance, anemia, anxiety and alcohol abuse), hospital-related factors (teaching hospitals, high quintile hospitals), as independent predictors of 30-day UC readmission. Colonoscopy, Cannabis use, and colectomy were associated with decreased odds of 30-day readmission. The most common cause of UC was septicemia.
CONCLUSIONS
This is the largest nationwide study demonstrating predictors of 30-day readmission, mortality and morbidity associated with UC. Identification and amelioration of these risk factors will decrease readmission rate and mortality amongst UC patients.
Identifiants
pubmed: 34034271
doi: 10.1097/MEG.0000000000002147
pii: 00042737-202109000-00006
doi:
Substances chimiques
Biological Products
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1174-1184Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Stawowczyk E, Kawalec P. A systematic review of the cost-effectiveness of biologics for ulcerative colitis. PharmacoEconomics. 2018; 36:419–434.
Amiot A, Peyrin-Biroulet L. Current, new and future biological agents on the horizon for the treatment of inflammatory bowel diseases. Therap Adv Gastroenterol. 2015; 8 66–82.
Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017; 389:1756–1770.
Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S; AGA Institute Clinical Guidelines Committee. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020; 158:1450–1461.
Park SC, Jeen YT. Current and emerging biologics for ulcerative colitis. Gut Liver. 2015; 9:18–27.
Crohnscolitisfoundation.org. 2021. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/recently-approved-treatments.pdf . [Accessed 28 April 2021]
Siegel CA, Yang F, Eslava S, Cai Z. Treatment pathways leading to biologic therapies for ulcerative colitis and Crohn’s disease in the United States. Clin Transl Gastroenterol. 2020; 11:e00128.
Bewtra M, Su C, Lewis JD. Trends in hospitalization rates for inflammatory bowel disease in the United States. Clin Gastroenterol Hepatol. 2007; 5:597–601.
Samuel S, Ingle SB, Dhillon S, Yadav S, Harmsen WS, Zinsmeister AR, et al. Cumulative incidence and risk factors for hospitalization and surgery in a population-based cohort of ulcerative colitis. Inflamm Bowel Dis. 2013; 19:1858–1866.
Poojary P, Saha A, Chauhan K, Simoes P, Sands BE, Cho J, et al. Predictors of hospital readmissions for ulcerative colitis in the United States: a national database study. Inflamm Bowel Dis. 2017; 23:347–356.
Agency for Healthcare Research and Quality. The Nationwide Readmissions Database Overview. 2010. http://www.hcup-us.ahrq.gov/nrdoverview.jsp . [Accessed June 14, 2020].
Agency for Healthcare Research and Quality. The Nationwide Readmissions Database Overview. 2010. https://www.hcup-us.ahrq.gov/db/nation/nrd/Introduction_NRD_2010-2017.pdf . [Accessed 14 June 2020]
McCormick PJ, Lin HM, Deiner SG, Levin MA. Validation of the all patient refined diagnosis related group (APR-DRG) risk of mortality and severity of illness modifiers as a measure of perioperative risk. J Med Syst. 2018; 42:81.
Aslam F, Khan NA. Tools for the assessment of comorbidity burden in rheumatoid arthritis. Front Med (Lausanne). 2018; 5:39.
US Agency for Healthcare Research and Quality. Cost-to-charge ratio files. 2001. https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp . Accessed June 14, 2020.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011; 30:377–399.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360:1418–1428.
Riegler G, Tartaglione MT, Carratú R, D’Incá R, Valpiani D, Russo MI, et al. Age-related clinical severity at diagnosis in 1705 patients with ulcerative colitis: a study by GISC (Italian Colon-Rectum Study Group). Dig Dis Sci. 2000; 45:462–465.
Tully PJ, Baker RA, Turnbull D, Winefield H. The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med. 2008; 31:281–290.
Singh G, Zhang W, Kuo YF, Sharma G. Association of psychological disorders with 30-day readmission rates in patients with COPD. Chest. 2016; 149:905–915.
Bien J, Palagani V, Bozko P. The intestinal microbiota dysbiosis and Clostridium difficile infection: is there a relationship with inflammatory bowel disease? Therap Adv Gastroenterol. 2013; 6:53–68.
Mantzouranis G, Fafliora E, Saridi M, Tatsioni A, Glanztounis G, Albani E, et al. Alcohol and narcotics use in inflammatory bowel disease. Ann Gastroenterol. 2018; 31:649–658.
Vohra I, Attar B, Sharma S, Katiyar V, Jaiswal M. P129 Inpatient outcomes of sepsis in inflammatory bowel disease patients: a 2016 nationwide inpatient sample analysis. Inflamm Bowel Dis. 2020; 26 (Suppl_1):S25–S26.
Ananthakrishnan AN, McGinley EL. Infection-related hospitalizations are associated with increased mortality in patients with inflammatory bowel diseases. J Crohn’s Colitis. 2013; 7:107–112XXX.
Litz M, Rigby A, Rogers AM, Leslie DL, Hollenbeak CS. The impact of mental health disorders on 30-day readmission after bariatric surgery. Surg Obes Relat Dis. 2018; 14:325–331.
Villani A, Malfatto G, Compare A, Della Rosa F, Bellardita L, Branzi G, et al. Clinical and psychological telemonitoring and telecare of high risk heart failure patients. J Telemed Telecare. 2014; 20:468–475.
Stoner SA. Effects of Marijuana on Mental Health: Anxiety Disorders. Alcohol & Drug Abuse Institute, University of Washington; 2017. pp. 1–4.
Ahmed W, Katz S. Therapeutic use of cannabis in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2016; 12:668–679.
Matsuoka K, Kobayashi T, Ueno F, Matsui T, Hirai F, Inoue N, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol. 2018; 53:305–353.
Gunnells DJ Jr, Morris MS, DeRussy A, Gullick AA, Malik TA, Cannon JA, et al. Racial disparities in readmissions for patients with inflammatory bowel disease (IBD) after colorectal surgery. J Gastrointest Surg. 2016; 20:985–993.