Re-hospitalizations within 30-days and mortality outcomes among severely visually impaired and blind patients: analysis of the National Readmission Database.

ABSTRACT

BACKGROUND: Readmissions and in-hospital mortality among patients with severe vision impairment or blindness (SVI/B) has not been fully studied. We investigated hospital outcomes for adults with SVI/B in the United States. METHODS: Using the Nationwide Readmission Database year 2017, we analyzed primary outcomes for thirty-day readmission rates for patients with and without SVI/B. Secondary outcomes were in-hospital mortality rates for readmitted patients, in-hospital mortality rates for index patients, the five most common principal diagnoses for readmission, and resource utilization. RESULTS: 34,558 patients had an index admission for SVI/B vs. 24,600,000 who did not. Patients with SVI/B had a 13.3% [4,383] readmission rate within 30 days compared to 8.4% [2,033,329] without SVI/B. Compared to readmitted patients without SVI/B patients, those with SVI/B were older (mean [SD] age 64.4 [SD ± 19] vs. 61.4 [SD ± 20] years) and had more comorbidities (Charlson comorbidity score ≥ 3 79.2% [ 3,471] vs. 60.9% [1,238,299]). The mortality rate among patients readmitted with SVI/B was 5.38% [236] vs. 4.02% [81,740] for patients without SVI/B, p-value = 0.016. Top reasons for readmissions among patients with SVI/B included sepsis 12% [526], heart failure 10.5% [460)], acute renal failure 4.4% [193], complications due to type II diabetes mellitus 4.1% [178], and pneumonia 2.7% [118]. The mean length of stay for readmitted patients with SVI/B was 6.3 days (confidence interval [CI] 6.0-6.7 days), vs. 5.6 days for patients without SVI/B (CI 5.5-5.8 days), p-value < 0.01. The mean hospital charges for readmitted patients with SVI/B was $57,202 (CI $53,712-$61,292) vs. $51,582 (CI $49,966-$53,198), p-value < 0.01. CONCLUSION: Patients with SVI/B had higher readmission rates and greater mortality on readmissions than those without SVI/B. Interventional studies for optimal discharge strategies are critically needed to improve clinical and resource utilization outcomes in patients with SVI/B.