Hospital for Special Surgery, Department of Medicine, Division of Rheumatology, 535 East 70th Street, New York, NY 10021, United States.
Weill Cornell Medicine, Department of Healthcare Policy and Research, 402 East 67th Street, New York, NY 10065, United States.
Semin Arthritis Rheum. 2021 Feb;51(1):324-330. doi: 10.1016/j.semarthrit.2021.01.002. Epub 2021 Jan 8.
To identify risk-factors for 30-day hospital readmission in systemic sclerosis pulmonary hypertension (SSc-PH) and to compare trends and characteristics of 30-day readmissions in SSc-PH versus non-SSc pulmonary arterial hypertension (non-SSc PAH).
In this retrospective study, we identified SSc-PH and non-SSc PAH hospitalizations using ICD-9 codes within the Healthcare Cost and Utilization Project-National Readmission Database. Thirty-day readmission rates were calculated between 2010 and 2015. Characteristics were compared using chi-square, Wilcoxon rank-sum, or two-sample t-tests between (A) SSc-PH patients with versus without readmission and (B) patients with ≥1 readmission with SSc-PH versus non-SSc PAH. Adjusted logistic regression models were generated for readmission in SSc-PH.
4,846 of 22,420 (22%) with SSc-PH and 10,573 of 49,254 (21%) with non-SSc PAH had ≥1 30-day readmission. Between 2010-2015, readmission rate decreased in non-SSc PAH (23% to 20%; p<0.001) and was unchanged in SSc-PH (23% to 23%; p = 0.77). In SSc-PH, independent predictors of 30-day readmission include male sex, age <60, Medicare or Medicaid, higher Charlson/Deyo comorbidity index, and congestive heart failure (CHF). A higher proportion of patients with SSc-PH (vs. non-SSc PAH) died during index hospitalizations (p = 0.001) and readmissions (p <0.001). Readmitted patients with SSc-PH (vs. non-SSc PAH) were younger and less often had CHF. In SSc-PH, the most common readmission primary diagnosis was infection, followed by respiratory and heart failure.
In SSc-PH, 30-day readmission is frequent, and in-hospital deaths occur at a higher rate compared to those with non-SSc PAH. This study identifies factors that may characterize those with SSc-PH at highest risk for readmission.
确定系统性硬皮病肺动脉高压（SSc-PH）患者 30 天内再入院的风险因素，并比较 SSc-PH 与非系统性硬皮病相关肺动脉高压（non-SSc PAH）患者 30 天内再入院的趋势和特征。
本回顾性研究使用 Healthcare Cost and Utilization Project-National Readmission Database 中的 ICD-9 编码确定 SSc-PH 和 non-SSc PAH 住院患者。计算 2010 年至 2015 年的 30 天再入院率。使用卡方检验、Wilcoxon 秩和检验或两样本 t 检验比较（A）有或无再入院的 SSc-PH 患者和（B）有≥1 次再入院的 SSc-PH 患者与 non-SSc PAH 患者之间的特征。对 SSc-PH 再入院进行调整后的逻辑回归模型生成。
22420 例 SSc-PH 患者中有 4846 例（22%）和 49254 例 non-SSc PAH 患者中有 10573 例（21%）至少有一次 30 天再入院。2010 年至 2015 年间，non-SSc PAH 的再入院率从 23%降至 20%（p<0.001），而 SSc-PH 无变化（23%至 23%；p=0.77）。在 SSc-PH 中，30 天再入院的独立预测因素包括男性、年龄<60 岁、医疗保险或医疗补助、较高的 Charlson/Deyo 合并症指数和充血性心力衰竭（CHF）。在索引住院期间（p=0.001）和再入院期间（p<0.001），SSc-PH 患者的死亡比例高于 non-SSc PAH 患者。与 non-SSc PAH 患者相比，再入院的 SSc-PH 患者年龄较小，充血性心力衰竭较少。在 SSc-PH 中，最常见的再入院主要诊断是感染，其次是呼吸系统和心力衰竭。
在 SSc-PH 中，30 天再入院率较高，与 non-SSc PAH 相比，院内死亡发生率更高。本研究确定了可能导致 SSc-PH 患者再入院风险最高的因素。
