Thirty-Day Hospital Readmissions for Acute Gout in the United States: Analysis of the Nationwide Readmission Database

Thirty-Day Readmissions After Hospitalization for Psoriatic Arthritis

Background Psoriatic arthritis (PsA) is correlated with higher rates of major adverse cardiovascular events and autoimmune disorders than the general population, leading to more frequent hospitalizations. This study assessed the rates and characteristics of index and 30-day readmissions among adults hospitalized for PsA and evaluated the indications and predictors of 30-day readmissions across the United States. Methodology We analyzed the 2020 Nationwide Readmissions Database for adult PsA hospitalizations using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. To compare baseline characteristics between index admissions and readmissions, we used chi-square tests. We used ranking commands to identify the most common indications for readmissions and multivariable Cox regression analysis to identify the predictors of readmissions. The primary endpoints were the rates and characteristics of index and 30-day readmissions. The secondary endpoint was the predictors of readmission within 30 days of index hospital discharge. Results Approximately 842 index hospitalizations for PsA were analyzed. Of these, 244 (29%) resulted in 30-day readmissions, with the primary causes being acute kidney failure, major depression, and heart failure. Readmitted patients had a mean age of 48.2 years (SD = 6.4 years) compared with 54.6 years (SD = 2.2 years) in index hospitalizations (p = 0.147). More readmitted patients were uninsured than index hospitalizations (18.6% vs. 4.4%; p = 0.015). The mean length of stay for readmissions was 7.2 days compared with 3.9 days for index admissions. The mean total hospital costs were US$31,424 for index admissions and US$60,147 for readmissions (p < 0.001). Significant differences in comorbidities such as hypertension (24.8% vs. 40.1%, p = 0.032), liver disease (29% vs. 7.9%, p = 0.020), uveitis (9.4% vs. 4.5%, p < 0.001), inflammatory bowel disease (8.6% vs. 3.8%, p < 0.001), and alcohol use disorder (29% vs. 7.8%, p = 0.002) were observed between readmissions and index admissions. Age <40 years (adjusted hazard ratio (AHR) = 2.35; p = 0.047), home healthcare (AHR = 5.87; p = 0.035), residence in the same state as the hospital (AHR = 1.24; p = 0.018), and secondary diagnoses of inflammatory bowel disease (AHR = 2.33; p < 0.001) or deep venous thrombosis (AHR = 3.80; p = 0.007) were correlated with an increased likelihood of readmission. Conclusions About one in three hospitalizations for PsA result in readmission within 30 days of initial discharge. Age <40 years, discharge to home healthcare, and a secondary diagnosis of inflammatory bowel disease or deep venous thrombosis were correlated with an increased likelihood of readmission.

Polymyositis/dermatomyositis readmissions: analysis of the nationwide readmission database

BACKGROUND

There is a scarcity of national population-based studies on polymyositis (PM)/dermatomyositis (DM) readmissions in the USA. In this study, we aim to describe the rates, reasons for readmissions, and characteristics of readmissions for adults hospitalized for PM/DM in the USA.

METHODS

We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult DM/PM patients with a principal diagnosis of PM/DM using ICD-10 codes. We excluded elective and traumatic readmissions. Using a "rank" command in STATA, the most common specific principal diagnosis of readmissions was outlined. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. STATA 16 was used for analysis.

RESULTS

A total of 1610, 1286, and 842 index hospitalizations with a principal diagnosis of PM/DM, that were discharged alive, were included in the 30-, 90-, and 180-day readmission analysis, respectively. Among these, 193 (12%), 276 (21.5%), and 240 (28.5%) were readmitted within 30, 90, and 180 days, respectively. PM and sepsis were the most common reasons for reasons across the 3 timeframes. 30-day readmissions were responsible for an aggregate of 4.1 million US dollars in total hospital cost and 1518 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions have higher Charlson Comorbidity Index scores, severe-extreme loss of function, obesity, and deep venous thrombosis.

CONCLUSION

About a third of PM/DM hospitalized patients are readmitted within 180 days. Readmissions constitute a significant economic burden to the health care system. PM and sepsis are the main reasons for readmissions. Key points • About a third of polymyositis (PM)/dermatomyositis (DM) hospitalized patients are readmitted within 180 days • PM and sepsis are the main reasons for readmissions. • Readmissions of PM/DM Patients constitute a significant economic burden to the health care system. • Compared to index hospitalizations, 30-day readmissions have higher Charlson comorbidity index scores, severe-extreme loss of function, obesity, and deep venous thrombosis.

Gout and Hospital Admission for Ambulatory Care-Sensitive Conditions: Risks and Trajectories

OBJECTIVE

To investigate the risks and trajectories of hospital admission for ambulatory care-sensitive conditions (ACSCs) in gout.

METHODS

Among individuals aged 35 years to 85 years residing in Skåne, Sweden, in 2005, those with no doctor-diagnosed gout during 1998 to 2005 (n = 576,659) were followed from January 1, 2006, until a hospital admission for an ACSC, death, relocation outside Skåne, or December 31, 2016. Treating a new gout diagnosis (International Classification of Diseases, 10th revision, code M10) as a time-varying exposure, we used Cox proportional and additive hazard models to estimate the effects of gout on hospital admissions for ACSCs. We investigated the trajectory of hospital admissions for ACSCs from 3 years before to 3 years after gout diagnosis using generalized estimating equations and group-based trajectory modeling in an age-and sex-matched cohort study.

RESULTS

Gout was associated with a 41% increased rate of hospital admission for ACSCs (hazard ratio 1.41, 95% CI 1.35-1.47), corresponding to 121 (95% CI 104-138) more hospital admissions for ACSCs per 10,000 person-years compared with those without gout. Our trajectory analysis showed that higher rates of hospital admission for ACSCs among persons with gout were observed from 3 years before to 3 years after diagnosis, with the highest prevalence rate ratio (2.22, 95% CI 1.92-2.53) at the 3-month period after diagnosis. We identified 3 classes with distinct trajectories of hospital admissions for ACSCs among patients with gout: almost none (88.5%), low-rising (9.7%), and moderate-sharply rising (1.8%). The Charlson Comorbidity Index was the most important predictor of trajectory class membership.

CONCLUSION

Increased risk of hospital admissions for ACSCs in gout highlights the need for better management of the disease through outpatient care, especially among foreign-born, older patients with comorbidities.