Thirty-Day Readmission Rate Is High for Hospitalized Patients Discharged With Home Parenteral Nutrition or Intravenous Fluids

• Published in: JPEN. Journal of parenteral and enteral nutrition 2017-11, Vol.41 (8), p.1278-1285
• Main Authors: Vallabh, Hiren, Konrad, Denise, DeChicco, Robert, Cresci, Gail, Lopez, Rocio, Steiger, Ezra, Kirby, Donald F.
• Format: Article
• Language: English
• Subjects: 30‐day readmission; Administration, Intravenous - statistics & numerical data; Adult; Aged; Catheter-Related Infections - complications; Dehydration - complications; Female; Follow-Up Studies; home nutrition support; home parenteral support; Humans; intravenous fluids; Male; Malnutrition - complications; Middle Aged; nutrition; parenteral nutrition; Parenteral Nutrition, Home - statistics & numerical data; Patient Discharge; Patient Readmission - statistics & numerical data; Retrospective Studies; Risk Factors
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607116664785

Background: Reducing hospital readmissions decreases healthcare costs and improves quality of care. There are no published studies examining the rate of, and risk factors for, 30-day readmissions for patients discharged with home parenteral support (HPS). Objective: Determine the rate of 30-day readmissions for patients discharged with HPS and whether malnutrition and other demographic or clinical factors increase the risk. Materials and Methods: Retrospective review of patients discharged with HPS from the Cleveland Clinic between July 1, 2013, and June 30, 2014, and followed by the Cleveland Clinic Home Nutrition Support Service. Results: Of the 224 patients studied, 31.6% (n = 71) had unplanned readmissions within 30 days of hospital discharge. Of these, 21.1% (n = 15) were HPS related, with catheter-related bloodstream infection (n = 5) and dehydration (n = 5) the most common. The majority of patients (84.4%) were diagnosed with malnutrition, but the presence or degree did not influence the readmission rate (P = .41). According to univariable analysis, patients with an ostomy (P = .037), a small bowel resection (P = .002), a higher HPS volume at discharge (P < .001), and a shorter period between HPS consult and hospital discharge (P < .026) had a lower risk of 30-day readmission than their counterparts. On multivariable analysis, patients had a higher risk of 30-day readmission if they had a history of heart disease (P = .048) and for every 1-unit increase in white blood cells (P = .026). Conclusions: Patients discharged with HPS have a high 30-day readmission rate, although most readmissions were not related to the HPS itself. The presence and degree of malnutrition were not associated with 30-day readmissions.