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Chen M, Ataga KI, Hankins JS, Zhang M, Gatwood JD, Wan JY, Bailey JE. Age-related differences in risks and outcomes of 30-day readmission in adults with sickle cell disease. Ann Hematol 2023; 102:2329-2342. [PMID: 37450055 DOI: 10.1007/s00277-023-05365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Literature on 30-day readmission in adults with sickle cell disease (SCD) is limited. This study examined the overall and age-stratified rates, risk factors, and healthcare resource utilization associated with 30-day readmission in this population. METHODS Using the Nationwide Readmissions Database, a retrospective cohort study was conducted to identify adult patients (aged ≥ 18) with SCD in 2016. Patients were stratified by age and followed for 30 days to assess readmission following an index discharge. The primary outcome was 30-day unplanned all-cause readmission. Secondary outcomes included index hospitalization costs and readmission outcomes (e.g., time to readmission, readmission costs, and readmission lengths of stay). Separate generalized linear mixed models estimated the adjusted odds ratios (aORs) for associations of readmission with patient and hospital characteristics, overall and by age. RESULTS Of 15,167 adults with SCD, 2,863 (18.9%) experienced readmission. Both the rates and odds of readmission decreased with increasing age. The SCD complications vaso-occlusive crisis and end-stage renal disease (ESRD) were significantly associated with increased likelihood of readmission (p < 0.05). Age-stratified analyses demonstrated that diagnosis of depression significantly increased risk of readmission among patients aged 18-to-29 years (aOR = 1.537, 95%CI: 1.215-1.945) but not among patients of other ages. All secondary outcomes significantly differed by age (p < 0.05). CONCLUSION This study demonstrates that patients with SCD are at very high risk of 30-day readmission and that younger adults and those with vaso-occlusive crisis and ESRD are among those at highest risk. Multifaceted, age-specific interventions targeting individuals with SCD on disease management are needed to prevent readmissions.
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Affiliation(s)
- Ming Chen
- Institute of Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jane S Hankins
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Min Zhang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Justin D Gatwood
- Institute of Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Nashville, TN, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Williams AO, Sridharan N, Rojanasarot S, Chaer R, Anderson N, Wifler W, Jaff MR. Population-Based Disparities in Inferior Vena Cava Filter Procedures Among Medicare Enrollees With Acute Venous Thromboembolism. J Am Coll Radiol 2022; 19:722-732. [PMID: 35487249 DOI: 10.1016/j.jacr.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Venous thromboembolism (VTE) imposes a significant clinical and financial burden on patients and society. Inferior vena cava filters (IVCFs) are considered for patients with absolute contraindications or failures of anticoagulation. However, studies examining the population-based disparities of IVCF placement and retrieval are limited. The association between patient and clinical characteristics in the likelihood of and time to IVCF placement and retrievals in a nationally representative cohort was examined. METHODS Medicare patients aged ≥65 years with index VTE claims between 2015 and 2018 were followed through 2019 to identify IVCF placements and retrievals. Rates were compared using survival analysis methods. RESULTS Of the 516,978 patients with VTE diagnoses, 5,864 (1.1%) had IVCFs placed, and 1,884 (32.1%) of those underwent retrieval procedures. Placement and retrieval rates varied significantly by demographics, comorbidity burden, and geographic region. From Cox regression, older age (hazard ratio [HR], 1.26; P < .0001), higher baseline comorbidity (Elixhauser) score (HR, 1.07; P < .0001), and outpatient (vs inpatient) site of VTE service (HR, 2.11; P < .0001) were associated with increased frequency of IVCF placement. The rate of retrieval was significantly lower for men (HR, 0.83; P = .0393), patients with higher comorbidity scores (HR, 0.95; P = .0037), and those with outpatient (vs inpatient) VTE sites of service (HR, 0.77; P = .0173). Neither facility- nor county-level characteristics were significantly associated with placements or retrievals. CONCLUSIONS This large cohort of Medicare beneficiaries with newly diagnosed VTE demonstrated inequities in IVCF placement and retrieval.
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Affiliation(s)
| | - Natalie Sridharan
- University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, Pennsylvania
| | | | - Rabih Chaer
- University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, Pennsylvania
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