Hospital readmission with Clostridium difficile infection as a secondary diagnosis is associated with worsened outcomes and greater revenue loss relative to principal diagnosis: A retrospective cohort study.
Medicine (Baltimore). 2018 Sep;97(36):e12212
Authors: Zilberberg MD, Nathanson BH, Marcella S, Hawkshead JJ, Shorr AF
Recurrent Clostridium difficile infection (rCDI) requiring rehospitalization contributes to poor outcomes, which may differ between patients hospitalized with versus for it.We performed a multicenter retrospective cohort study of rehospitalized adults surviving initial CDI hospitalization. Hospital mortality, length of stay (LOS), 30-day readmission, and mean gap between hospital costs and Diagnosis Related Group (DRG) reimbursement served as outcomes.Among the 25.7% (n = 99,175) survivors requiring rehospitalization, 36,504 (36.8%) had rCDI (14,005 [38.4%] principal diagnosis rCDI [PrCDI]). Compared with non-CDI, PrCDI, and secondary diagnosis rCDI [SrCDI] carried lower risk of death (PrCDI odds ratio [OR] 0.52; 95% confidence interval [CI] 0.46, 0.58; SrCDI OR 0.80; 95% CI 0.75, 0.85) and 30-day readmission (PrCDI OR 0.84; 95% CI 0.80, 0.88; SrCDI OR 0.97; 95% CI 0.94, 1.01), and excess LOS (PrCDI 1.8 days; 95% CI 1.7, 2.0; SrCDI 1.4 days; 95% CI 1.3, 1.5), and costs (PrCDI $1399; 95% CI $858, $1939; SrCDI $2809; 95% CI $2307, $3311). Mean gap between hospital costs and DRG reimbursements was highest in SrCDI ($13,803).A rehospitalization within 60-days of an initial CDI hospitalization occurs in approximately 25% of all survivors, 1/3 with rCDI. SrCDI carries worse outcomes than PrCDI. The potential loss of revenue incurred by the hospital is nearly 3-fold higher for SrCDI than PrCDI.
PMID: 30200134 [PubMed - in process]