Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Abstract

Background: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. Objective: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. Methods: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. Results: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. Conclusions: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

Cellulitis in older people over 75 years – are there differences?

“…Unlike previous published literature [18], we did not find a significant difference in the 28-day readmission rate between the two age cohorts in our study. As the readmission rate was less than 5%, a study with greater number of patients would have more power to detect small differences in readmission rates.…”

“…Hospital readmission for cellulitis is also more common in older people [18] particularly if there has been more than one prior episode of cellulitis 19.…”

Analysis of Readmissions Following Hospitalization for Cellulitis in the United States

“…Our estimated 30-day readmission rate after cellulitis discharge of 9.8% in a national cohort approximates a prior estimate of 11.2% within a single hospital system cohort. 6 The national readmission rate after index admissions for any diagnosis is estimated to be 14.5%. 7 The slightly lower rate of readmis-sions after cellulitis discharge relative to those after other illnesses likely reflects the younger mean age and general well-being of patients with cellulitis.…”

A Multicomponent Intervention to Reduce Readmissions Among People With HIV

“…In addition to the abovementioned variables, those that were included in the previously published EHR risk prediction model (e-model) for 30-day readmissions among patients with HIV 14 were collected including history of AIDS-defining illness, bicarbonate (HCO 3 ), aspartate aminotransferase (AST), alanine aminotransferase (ALT), hematocrit (HCT), PO 2 (partial pressure of oxygen), anion gap, absolute lymphocyte count, and distance of residence from hospital. For people with cellulitis, there was no existing e-model for the 30-day readmission risk, although variables cited in the literature as contributing to readmissions for patients with cellulitis 28,29 were collected as part of the baseline measures including age, insurance, creatinine, WBC count, diabetes mellitus, venous insufficiency, homelessness, length of stay, previous emergency department (ED) visits, and previous hospitalization.…”