Risk factors and costs associated with 30-day readmissions following alcohol-related hospitalizations in the United States from 2010 to 2015

• Published in: Alcohol (Fayetteville, N.Y.) N.Y.), 2020-12, Vol.89, p.19-25
• Main Authors: Silverstein, Alison R., Kee, Rebecca, Gleeson, Carole D., Sussell, Jesse, O'Sullivan, Amy K., Goldman, Dana P., Hasin, Deborah
• Format: Article
• Language: English
• Subjects: 30-day readmissions; Adults; Alcohol use; Alcohol use disorder; Alcohol-related hospitalization; Audits; Calendars; Diagnosis; Drug therapy; Hospital costs; Hospitalization; Patients; Regression analysis; Risk factors; Risk groups
• ISSN: 0741-8329; 1873-6823
• DOI: 10.1016/j.alcohol.2020.08.003

Patients with alcohol-related diagnoses at initial hospitalization are at high risk of 30-day readmission. Understanding risk factors for 30-day readmission among these patients may help to identify those who would benefit from efforts to reduce risk of readmission. The Nationwide Readmissions Database was used to estimate 30-day all-cause readmissions among United States patients with an alcohol-related index hospitalization and to evaluate risk factors and costs associated with these readmissions. Included patients were 18 years of age or older at initial hospitalization, had an alcohol-related primary diagnosis (based on ICD-9-CM codes), and were discharged between 2010 and 2015. They were followed for 30 days after initial hospitalization within the calendar year to identify all-cause readmissions. A logistic regression analysis assessed the association between risk factors and 30-day readmission. Average costs of initial admissions and readmissions were estimated. Among 113,931,723 adult index hospitalizations, 1,124,228 had alcohol-related diagnoses. Patients had a mean age of 49 years, 73% were male, and 45% had public insurance coverage. The annual rate of 30-day readmissions among patients with index alcohol-related hospitalizations increased from 119 readmissions per 1000 admissions in 2010 to 140 per 1000 in 2015, while the rate of readmissions among patients with all-cause hospitalizations declined from 103 to 98 per 1000. The regression analysis suggested that age, male sex, comorbid conditions, discharge against medical advice, admission to large and teaching hospitals, and Medicaid vs. non-Medicaid payment were all risk factors for 30-day readmission. Mean costs of initial alcohol-related hospitalizations were greater among those with a 30-day readmission than without a 30-day readmission, and the mean cost of 30-day readmission was even greater. Mitigating the upward trend in rates of readmission following alcohol-related initial hospitalizations may be addressed through better identification of high-risk patients who are admitted with an alcohol-related diagnosis and greater use of existing evidence-based psychosocial and pharmacotherapy treatment methods. •Rates of 30-day readmissions after alcohol-related admissions increased from 2010 to 2015 in the United States.•Comorbid conditions were more common among patients with readmission vs. without readmission.•Alcohol abuse and discharge against medical advice strongly predicted readmission