There is sparse data on real time rates, trends and predictors readmission rates of ulcerative colitis. We aim to find national real time rates, trends and predictors of readmission.Methods:
We utilized National Readmission Data (NRD) 2013, a subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). Crohn's Disease was identified using ICD 9 code (556.xx) as primary diagnosis. Patients with missing information on age, gender and mortality were removed. Patient with age < 18 were removed as well. Patients were followed over next 30 days with help of “NRD_VisitLink” and “NRD_DaysToEvent” variables. Co-morbidities were identified by “cm_” variables in HCUP database. Comorbid conditions were defined by Charlson's Comorbidity Index (CCI). Primary outcome of study was 30-days readmission. We ran 2 level hierarchical logistic model to find out predictors of outcomes. Readmission etiologies were identified with ICD 9 diagnosis codes in primary diagnosis field.Results:
Twelve thousand thirteen patients were identified with ulcerative colitis, which were national representative of 27,552. Mean age of patients was 48.8 ± 0.2 and 53.38% of patients were female. 1734/12,013 (14.43%) patients were readmitted with total of 2020 readmissions over 30 days post discharge. 1489/1734 (85.87%), 206/1734 (11.88%) and 39/1734 (2.25%) patients were readmitted one, 2 and more than equal to 3 times respectively. 25%, 50% and 75% of readmissions took place in 7, 14 and 21 days respectively. 685/2020 (33.92%) readmissions were due to ulcerative colitis. On multivariate analysis, Patients with older age (OR: 95% Confidence Interval [CI], P value] (1.01, 1.01–1.01, P = 0.03), higher charlson score (CCI ≥ 2: 1.46, 1.24–1.72, P < 0.001) compared to CCI-0, heart failure (1.20, 1.01–1.15, P = 0.04), anemia (1.27, 1.17–1.38, P < 0.001), Emergent admission (1.35, 1.22–1.49, P < 0.001) were associated with increase in readmission. While, Female patients (0.93, 0.27–0.99, P = 0.04) with peripheral vascular disease (0.73, 0.59–0.90, P = 0.003) and private insurance (0.76, 0.69–0.83, P < 0.001) compared to medicare/mediaid were associated with decrease in readmission rates. Non influential co morbidities were obesity, liver disease, diabetes, hypertension, renal failure, chronic lung disease, arthritis. 69/12,013 (0.57%) patients died during index admission and 29/20.20 (1.44%) patients died during readmission.Conclusion:
Patient's with ulcerative colitis has striking 14% readmission rate regardless of the age. Sicker patient population and population with comorbidities has higher readmission rate. National average of readmission will help institutes to set the bar for their own community and predictors of readmission will help to identify high risk patient population and to do additional intervention to prevent readmissions.