Analysis of Readmissions Following Hospitalization for Cellulitis in the United States

Abstract

IMPORTANCE Cellulitis commonly results in hospitalization. Limited data on the proportion of cellulitis admissions associated with readmission are available.OBJECTIVE To characterize the US national readmission rate associated with hospitalization for treatment of cellulitis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort analysis of cellulitis admissions from the nationally representative 2014 Nationwide Readmissions Database calculated readmission rates for all cellulitis admissions and subsets of admissions. The multicenter population-based cohort included adult patients admitted for conditions other than obstetrical or newborn care. Data were collected from January 1 through November 30, 2014, and analyzed from February 1 through September 18, 2018. Bivariate logistic regression models were used to assess differences in readmission rates by patient characteristics. Costs were calculated for all readmissions after discharge from hospitalization for cellulitis (hereinafter referred to as cellulitis discharge) and by readmission diagnosis.EXPOSURES Admission with a primary diagnosis of cellulitis. MAIN OUTCOMES AND MEASURES Proportion of cellulitis admissions associated with nonelective readmission within 30 days, characteristics of patients readmitted after cellulitis discharge, and costs associated with cellulitis readmission.RESULTS A total of 447 080 (95% CI, 429 927-464 233) index admissions with a primary diagnosis of cellulitis (53.8% male [95% CI, 53.5%-54.2%]; mean [SD] age, 56.1 [18.9] years) were included. Overall 30-day all-cause nonelective readmission rate after cellulitis discharge was 9.8% (95% CI, 9.6%-10.0%). Among patients with cellulitis, age (odds ratio for 45-64 years, 0.78; 95% CI, 0.75-0.81; P = .001) and insurance status (odds ratio for Medicare, 2.45; 95% CI, 2.33-2.58; P < .001) were associated with increased readmission rates. The most common diagnosis of readmissions included skin and subcutaneous tissue infections. The total cost associated with nonelective readmissions attributed to skin and subcutaneous infections within 30 days of a cellulitis discharge during the study period was $114.4 million (95% CI, $106.8-$122.0 million).CONCLUSIONS AND RELEVANCE Readmission after hospitalization for cellulitis is common and costly and may be preventable with improved diagnostics, therapeutics, and discharge care coordination.

Comparisons of 30-Day Admission and 30-Day Total Healthcare Costs Between Patients Who Were Treated With Oritavancin or Vancomycin for a Skin Infection in the Outpatient Setting

“…Most notably, this study included a broader patient population and many patients included in this study were excluded from the SOLO trials. However, the hospital admission rates observed in this study are consistent with those reported in the literature [23]. Future, well-powered comparator studies are needed to validate the findings from this study.…”

The Real-World Economic and Clinical Management of Adult Patients with Skin and Soft Tissue Infections (SSTIs) with Oritavancin: Data from Two Multicenter Observational Cohort Studies

“…Similarly, all-cause and infection-related 30-day readmission rates were 6.6% and 2.6%, respectively, among patients who received oritavancin at hospital discharge (cohort 2). In both cases, the rates of hospital admission post oritavancin treatment were lower than nationally reported rates of overall (20%) and infection-related (10%) readmissions for patients with SSTIs [31]. It should be noted that not every admission/readmission may have been captured, as a small number of patients may have been referred to another health system.…”

“…Recent data also show that 9.8% of patients with cellulitis were readmitted in US hospitals; age and insurance status were the main risk factors. Moreover, overall annual costs associated with nonelective readmissions due to SSTIs within 30 days of a cellulitis discharge in the US were estimated to total USD 114.4 million (95% CI: USD 106.8-122.0 million) [31].…”

New Developments in Bacterial, Viral, and Fungal Cutaneous Infections

“…A 2019 review reported that the readmission rate of hospital admissions due to cellulitis was 9.8% in 2014 resulting in a cost of $114.4 million for non-selective readmission attributed to skin infection within 30 days of cellulitis discharge [31]. This can be attributed to misdiagnosis as well as improper treatment and management.…”