Predictors of Early Readmission in Hospitalized Patients with Inflammatory Bowel Disease.

ABSTRACT

BACKGROUND: Readmissions are being increasingly used as an indicator of quality of care. We sought to identify risk factors for 30-day readmission in hospitalized patients with inflammatory bowel disease. METHODS: Patients with inflammatory bowel disease hospitalized between 2004 and 2013 at the University of Maryland were identified. Demographic and clinical information were extracted from the medical record for each admission. Multivariate logistic regression was performed to determine the association between these variables and readmission. RESULTS: One thousand two hundred thirteen admissions were identified in 498 patients; 232 (19.1%) index admissions were followed by a 30-day readmission. Mean age was 39.4 ± 14.5 years. Approximately 70% of the population was white, 60% were women, and 67.5% had Crohn's disease. Concurrent congestive heart failure and chronic obstructive pulmonary disease, history of steroid use, diverting ileostomy, subtotal colectomy, or a thromboembolic event during index admission, and IV antibiotics or restricted diet at discharge were associated with readmission. After adjustment, patients with congestive heart failure or chronic obstructive pulmonary disease were more likely to be readmitted (aOR 4.06 and 2.86, respectively). Underweight or obese patients were nearly twice as likely to be readmitted (aOR 1.81 and 1.72, respectively). Those with past steroid use, new ileostomy, or those who were discharged on hyperalimentation were twice as likely to be readmitted (aOR 1.90, 2.04, and aOR 1.97, respectively). CONCLUSIONS: Nineteen percentage of patients with inflammatory bowel disease treated at a referral center are readmitted within 30 days. Our results suggest that patients with comorbid medical conditions, malnutrition or obesity, a new ileostomy, past steroid use, or those discharged on hyperalimentation are at increased risk for readmission. Research is needed to determine if targeted interventions for high-risk patients decreases readmissions.