Thirty-day Readmission Among Patients With Non-variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes.
Gastroenterology. 2018 Mar 27;:
Authors: Abougergi MS, Peluso H, Saltzan JR
Abstract
BACKGROUND & AIMS: We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage (NVUGIH) and its impact on mortality, morbidity and healthcare utilization in the United States.
METHODS: We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults hospitalized for urgent NVUGIH and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation (PMV) and resource utilization (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis.
RESULTS: The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P<.01). A higher proportion of readmitted patients had morbidities requiring PMV (1.5%) compared to index admissions (0.8%) (P<.01). A total of 133,368 hospital days was associated with readmission, and the total healthcare in-hospital economic burden was $30.3 million (in costs) and $108 million (in charges). Independent predictors of readmission were Medicaid insurance, higher Charlson comorbidity score, lower income, residence in a metropolitan area, hemorrhagic shock, and longer stays in the hospital. Older age, private or no insurance, upper endoscopy, and PMV were associated with lower odds for readmission.
CONCLUSIONS: In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource utilization. Most readmissions are not for recurrent gastrointestinal bleeding.
PMID: 29601829 [PubMed - as supplied by publisher]