Among patients who receive medical treatment for inflammatory bowel disease, nearly 20% are readmitted to the hospital within 30 days, according to results of an analysis published in Clinical Gastroenterology and Hepatology.
Siddarth Singh, MD, MS, of the division of gastroenterology at the University of California San Diego, and colleagues wrote that because of the costs and length of hospital stay associated with IBD care, identifying patients who might be at the highest risk for readmission is crucial.
“Recent claims-based studies, for example, those utilizing nationwide readmissions databases have relied on non-validated administrative claims codes to identify patients with IBD, are limited to 1 year, and provide limited information on outpatient management, medication use and other objective parameters that may significantly modify risk of readmission,” they wrote. “Moreover, these are typically encounter-based estimates, rather than individual patient-level estimates. Other large studies estimate rate and risk factors associated with surgically treated IBD.”
Researchers searched the literature for studies that focused on the rate of hospital readmission, as well as the associated causes and risk factors among patients who received medical treatments for IBD. They used these data to estimate 30- and 90-day readmission and to identify causes and risk factors associated with readmission.
Singh and colleagues estimated that the 30-day readmission rate was 18.1% (95% CI, 14.4%–22.4%), and the 90-day readmission rate was 26% (95% CI, 22.7%–29.6%). Studies that had higher proportions of patients with ulcerative colitis than patients with Crohn’s disease had higher readmission rates.
IBD flares, infection and complications from unplanned surgeries during hospitalizations were the most common reasons for readmission, while the most common risk factors for 30-day readmission were admission for pain control (OR = 2.27; 95% CI, 1.69–3.03), need for total parenteral nutrition on discharge (OR = 2.13; 95% CI, 1.36–3.35) and prior or unplanned surgery during admission (OR = 3.11; 95% CI, 2.27–4.25).
Singh and colleagues called for future studies to explore intervention to reduce the risk for readmission.
“Development of population health management strategies focusing on identification of high-risk patients and development and implementation of multi-dimensional post-discharge transitional care interventions is warranted to improve quality of care, population health outcomes and reduce costs of care,” they wrote. – by Alex Young
Disclosures: Singh reports receiving research grants from AbbVie, as well as consulting fees from AbbVie, AMAG Pharmaceuticals, Pfizer and Takeda. Please see the full study for all other authors’ relevant financial disclosures.