Department of Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia.
Department of Medicine, UMass Medical Center, Springfield, Massachusetts.
Eur J Gastroenterol Hepatol. 2022 Jan 1;34(1):11-17. doi: 10.1097/MEG.0000000000002027.
Patients with gastrointestinal angiodysplasia (GIA)-related bleeding are at high risk for readmissions, resulting in significant morbidity and an economic burden on the healthcare system.
The aim of the study was to determine the 30-day readmission rate with reasons, predictors, and costs associated with GIA-related bleeding in the USA.
We queried the National Readmission Database to identify patients hospitalized with GIA-related bleeding in the year 2016 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Primary outcomes included the 30-day readmission rate, and secondary outcomes were in-hospital mortality and resource utilization for index and re-hospitalizations. We also performed univariate and multivariate cox regression analysis to identify predictors of readmissions.
A total of 25 079 index hospitalizations for GIA-related bleeding were identified in 2016. Out of these, 5047 (20.34%) patients got readmitted within the next 30 days. The most common diagnosis associated with readmissions were related to recurrent gastrointestinal bleeding. Readmissions compared to index hospitalization has significantly higher length of stay (5.38 vs. 5.11 days, P = 0.03), but mean hospitalization charges ($52 114 vs. $49 691, P = 0.11) and mean total hospitalization costs ($12 870 vs. $12 405, P = 0.16) were similar. Patients with multiple co-morbidities, length of stay >5 days, and end-stage renal disease were found to be independent predictors for 30-day readmissions.
Our study shows that one in five patients hospitalized with GIA-related bleeding was readmitted within 30 days of index hospitalization, placing a heavy economic burden on the healthcare system. Further research identifying strategies to reduce readmissions in these patients is needed.
胃肠道血管发育不良(GIA)相关出血的患者再入院风险较高,导致发病率较高,并给医疗保健系统带来经济负担。
本研究旨在确定美国 GIA 相关出血患者的 30 天再入院率及其相关原因、预测因素和费用。
我们使用国际疾病分类第 10 版(ICD-10)代码,在国家再入院数据库中查询 2016 年因 GIA 相关出血住院的患者。主要结局包括 30 天再入院率,次要结局为指数和再次住院的院内死亡率和资源利用。我们还进行了单变量和多变量 Cox 回归分析,以确定再入院的预测因素。
2016 年共确定了 25079 例 GIA 相关出血的指数住院治疗。其中,5047 例(20.34%)患者在接下来的 30 天内再次入院。与再入院相关的最常见诊断与复发性胃肠道出血有关。与指数住院相比,再入院的住院时间明显更长(5.38 天比 5.11 天,P=0.03),但平均住院费用(52114 美元比 49691 美元,P=0.11)和平均总住院费用(12870 美元比 12405 美元,P=0.16)相似。存在多种合并症、住院时间>5 天和终末期肾病的患者被发现是 30 天再入院的独立预测因素。
我们的研究表明,每 5 例因 GIA 相关出血住院的患者中就有 1 例在指数住院后 30 天内再次入院,这给医疗保健系统带来了沉重的经济负担。需要进一步研究确定减少这些患者再入院的策略。