PD-199 YI The Burden of Hospital Readmissions for Inflammatory Bowel Diseases Among Pediatric Patients in a Nationwide Database

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Abstract

Background:

Given the significant costs associated with hospitalization for patients with inflammatory bowel disease (IBD), increased focus has been placed on the prevention of hospital readmission among patients with IBD. Prior literature has suggested that pediatric patients with IBD are at greater risk for readmission than adult patients. There is a paucity of literature from nationally representative databases regarding the factors associated with hospital readmissions in pediatric patients with IBD, and thus we aimed to evaluate the burden of hospital readmissions among pediatric patients with IBD using the Nationwide Readmissions Database (NRD).

Methods:

We performed a retrospective cohort study using 2013 data from the NRD, a nationally representative database from the Healthcare Cost and Utilization Project. With data from 21 states, the NRD can be used to create national estimates of readmission rates for all payers and the uninsured. International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes were used to identify pediatric patients with discharge diagnoses of ulcerative colitis (UC) or Crohn's disease (CD). Among patients <18 years of age with IBD, available demographic factors and details of the index hospitalization and readmissions were determined. Bivariate and multivariate analyses were performed using SAS survey procedures.

Results:

We identified 3936 hospitalizations for patients with IBD (62% CD, 38% UC; 47% female, mean age 13.7 yr). The median length of stay for the index admission was 3.46 (Standard Deviation [SD] 0.07) days. A majority (90%) of patients were admitted to teaching hospitals. Of 2445 patients with CD, 11% underwent abdominal surgery or colectomy while 10.4% of 1491 patients with UC underwent abdominal surgery or colectomy during the index admission. A total of 939 (24%) patients were readmitted within 90 days of the index hospitalization. The median length of stay for the initial readmission was 3.9 (SD 0.14) days. The 5 most frequent primary diagnoses for patients with IBD who were readmitted were: CD (37%), UC (29%), Clostridium difficile colitis (2.2%), intestinal obstruction (1.5%), and attention to ileostomy (1.1%). Of patients who underwent a colectomy or abdominal surgery during the index admission, 23.7% experienced a readmission compared to 23.2% of patients who did not undergo a colectomy or abdominal surgery during the index admission. On multivariate analysis, admission to a non-teaching hospital was associated with an increased odds of readmission as compared to admission to a teaching hospital (OR 1.70 = 95% CI, 1.29–2.25). Age, sex, abdominal surgery or colectomy during index admission, and IBD subtype were not predictive of readmission. The mean cost associated with hospital readmission was $57,526 (SD 3.948).

Conclusions:

Hospital readmission represents a significant burden to pediatric patients with IBD. After CD and UC, Clostridium difficile colitis and intestinal obstruction were some of the most common reasons for hospital readmission within 90 days. The cost associated with readmission is high, and thus identifying risk factors for readmissions in patients with IBD has the potential to significantly decrease costs and resource utilization in this population.

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