Close outpatient follow-up associated with reduced readmission rates in patients with inflammatory bowel disease

Background

Few studies have shown the effects of prompt outpatient follow-up in relation to reducing readmission rates in patients hospitalized with inflammatory bowel disease (IBD). Our study evaluated whether postdischarge follow-up was associated with fewer IBD-related readmissions.

Methods

This single-center retrospective study included 477 patients with Crohn's disease (CD) or ulcerative colitis (UC) who were readmitted to our tertiary care hospital from January 1, 2016, to June 1, 2022. Rehospitalization admissions were defined as admissions that occurred within 90 days after discharge date. We used a chi-square or Fisher's exact test to test for bivariate comparisons to determine if there was an association in patients readmitted for IBD and primary care or gastroenterology follow-up at 1, 2, 3, and 4 weeks versus no follow-up.

Results

In UC patients, there were 118 admissions from 2016 to 2022; 36/118 (31%) and 41/118 (34.7%) of the patients were readmitted at 30 days and 90 days, respectively. In the CD group, there were 101 (36.73%) readmissions among 277 patients, with 174 nonreadmissions (63.27%).

Conclusions

Gastroenterology follow-up within 1 month was associated with reduced rates of admission in both groups (P < 0.05). This study highlights the importance of close gastroenterology follow-up for IBD-related hospitalizations.

Increasing thirty-day readmissions of Crohn's disease and ulcerative colitis in the United States: A national dilemma

BACKGROUND

The prevalence of Crohn's disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.

AIM

To identify trends and adverse outcomes for 30 d readmissions for CD and UC.

METHODS

This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant.

RESULTS

Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions.

CONCLUSION

There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.

Risk Factors Affecting 90-day Readmission of Patients with Inflammatory Bowel Disease

BACKGROUND: The rate of hospital readmission is seen as a measure of quality and accountability. Knowing the risk factors that can be changed could reduce the cost burden on patients with inflammatory bowel disease (IBD) and the health system. METHODS: Retrospective analysis was performed on the data extracted from hospital records during a 4-year period. The study setting encompassed three referral hospitals in Tehran and the south of Iran. The primary outcome was hospital readmission of patients with IBD. The factors associated with binary and categorical dependent variables were analyzed using robust logistic regression and multinomial logistic regression, respectively. The significance level was set at P=0.05. RESULTS: 187 patients were admitted during the 4-year study period for an IBD-related reason, among whom 131 patients (70.1%) had ulcerative colitis (UC), and 56 patients (29.9%) had Crohn's disease (CD). Moreover, 29% (55) of the participants had been readmitted at least once during the study period, and seven patients with IBD had been readmitted five or more times during the study period. Corticosteroids (OR=4.55, 95% confidence interval CI: 1.65- 12.55) and chronic pain (OR=6.65, 95% CI: 1.73-25.62) were two factors associated with their readmission within 90 days. For the patients with five or more times of readmissions, Corticosteroids (RRR=5.68), chronic pain (RRR=5.05), length of hospital stay (RRR=0.69), and age (RRR=0.9) could significantly explain the hospital readmissions. CONCLUSION: About one in seven hospitalizations of patients with IBD leads to 30-day readmission. Moreover, younger patients with IBD and shorter length of hospital stay were more likely to be readmitted five or more times during the study period. The use of corticosteroids and the presence of chronic pain were predictors of 90-day readmission. More studies are needed to detect the best management plan for chronic pains.