Department of Internal Medicine and Medical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, USA.
Department of Pediatrics and Neonatology, Beth Israel Deaconess Medical Center, Boston, USA.
Sci Rep. 2020 Feb 7;10(1):2082. doi: 10.1038/s41598-020-58934-3.
The 30-day readmission rate after hospitalization for a sickle cell crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1-5.5) vs 4.9 days (CI 4.8-5.1, p < 0.01). Also, the mean cost of hospitalization in readmitted patients $8485 was significantly higher than the index hospitalization $8064 p < 0.01. In 2016, readmission among patients with SCC incurred an additional 95,445 hospitalization days resulting a total charge of $609 million and a total cost of $152 million in the US. On Multivariate analysis, age group 18-30 years, discharge against medical advice, higher Charlson comorbidity index, low socioeconomic status and admission at high volume centers were associated with a higher likelihood of 30-day readmission. Among patients hospitalized for SCC, 30-day readmissions were frequent throughout the month post hospitalization and resulted in an enormous financial burden on the United States healthcare system.
镰状细胞危象（SCC）住院后 30 天再入院率极高。为了有效规划资源配置并计划干预措施以降低再入院率，需要准确了解再入院诊断、总再入院费用以及与再入院相关的因素。本研究旨在探讨 SCC 住院后所有原因 30 天再入院的再入院诊断和相关因素。我们分析了 2016 年全国再入院数据库（NRD），以根据患者人口统计学特征和 SCC 后住院时间来确定 30 天再入院的模式。我们估计了出院后 30 天和 7 天再入院的百分比和最常见的再入院诊断。我们研究了危险因素与再入院的关系以及再入院对患者结局和医疗保健费用的影响。2016 年，67887 例指数住院患者中，有 18099 例（26.9%）在 30 天内再次入院。在所有再入院中，有 5166 例（7.6%）在 7 天内再次入院。30 天和 7 天再入院的再入院诊断范围大致相似，两个时间段中有超过 80%的患者因与 SCC 相关的诊断而再次入院。再入院患者的平均住院时间明显长于指数住院时间（5.3 天（5.1-5.5）vs. 4.9 天（CI 4.8-5.1，p<0.01）。此外，再入院患者的住院费用为 8485 美元，明显高于指数住院费用 8064 美元（p<0.01）。2016 年，SCC 患者的再入院导致美国额外增加了 95445 天的住院治疗，总费用为 6.09 亿美元，总成本为 1.52 亿美元。多变量分析显示，18-30 岁年龄组、出院时违背医嘱、较高的 Charlson 合并症指数、较低的社会经济地位和在高容量中心入院与 30 天再入院的可能性更高相关。在因 SCC 住院的患者中，30 天再入院在整个住院后一个月内很常见，给美国医疗保健系统带来了巨大的经济负担。
