Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

• Published in: Inflammatory bowel diseases 2017-06, Vol.23 (6), p.875-881
• Main Authors: Barnes, Edward L, Kochar, Bharati, Long, Millie D, Kappelman, Michael D, Martin, Christopher F, Korzenik, Joshua R, Crockett, Seth D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety - epidemiology; Chronic Pain - epidemiology; Comorbidity; Databases, Factual; Depression - epidemiology; Female; Humans; Inflammatory Bowel Diseases - epidemiology; International Classification of Diseases; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Readmission - statistics & numerical data; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Tobacco Use - epidemiology; United States - epidemiology; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1097/MIB.0000000000001121

Previous studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBDs). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors. We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis or Crohn's disease and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidities during index admission. Logistic regression was used to estimate factors associated with hospital readmission. Among 52,498 hospitalizations of patients with IBD (63% Crohn's disease and 37% ulcerative colitis), 12,407 (24%) were readmitted within 90 days of the index hospitalization, resulting in roughly $576 million in excess charges. In multivariable analysis of patients with Crohn's disease, anxiety (odds ratio [OR] 1.31, 95% confidence interval [CI], 1.21-1.43), depression (OR 1.27, 95% CI, 1.07-1.50), chronic pain (OR 1.31, 95% CI, 1.18-1.46), and tobacco abuse (OR 1.13, 95% CI, 1.06-1.22) were associated with a significant increase in odds of readmission. Among patients with ulcerative colitis, anxiety (OR 1.28, 95% CI, 1.14-1.45), depression (OR 1.35, 95% CI, 1.07-1.70), and chronic pain (OR 1.44, 95% CI, 1.21-1.73) were associated with a significant increase in odds of readmission. Readmission occurs frequently in patients with IBD and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90-day hospital readmission in this population.