Opioid, Cocaine, and Amphetamine use Disorders are Associated with Higher30-Day Inpatient Readmission Rates in the United States

Abstract

Background: Patients with substance use disorders (SUDs) are more likely to experience serious health problems, high healthcare utilization, and premature death. However, little is known about the contribution of SUDs to medical 30-day readmission risk. We examined the association between SUDs and 30-day all cause readmission among non-pregnant adult in-patients in the US. Methods: We conducted a retrospective study using 2010–2014 data from the Nationwide Readmissions Database. Our primary focus was on opioid use compared to stimulant use (cocaine and amphetamine) identified by ICD-9-CM diagnosis codes in index hospitalizations. Multivariable logistic regression models were used to estimate adjusted odds ratios and 95% CI representing the association between substance use and 30-day readmission, overall and stratified by the principal reason for the index hospitalization. Results: Nearly 118 million index hospitalizations were included in the study, 4% were associated with opioid or stimulant use disorder. Readmission rates for users (19.5%) were higher than for nonusers (15.7%), with slight variation by the type of substance used: cocaine (21.8%), opioid (19.0%), and amphetamine (17.5%). After adjusting for key demographic, socioeconomic, clinical, and health system characteristics, SUDs and stimulant use disorders increased the odds of 30-day all-cause readmission by 20%. Conclusions: Reducing the frequency of inpatient readmission is an important goal for improving the quality of care and ensuring proper transition to residential/outpatient care among patients with SUDs. Differences between groups may suggest directions for further investigation into the distinct needs and challenges of hospitalized opioid- and other drug-exposed patients.

Real-world effectiveness of long-acting injectable antipsychotics to reduce 90-day and annual readmission in psychotic disorders: insights from a state psychiatric hospital

“…Consistent with current literature, demographic characteristics (age, gender, and race) did not predict psychiatric readmission 10 11 As per a nationwide study, stimulant-use disorders increases the odds of 30-day all-cause readmission by 20% 12 . Among substance use disorders (SUDs), we found that stimulant abuse/dependence increase the odds for 90-day and annual psychiatric readmission by two times.…”

“…10,11 As per a nationwide study, stimulant-use disorders increases the odds of 30-day all-cause readmission by 20%. 12 Among substance use disorders (SUDs), we found that stimulant abuse/dependence increase the odds for 90-day and annual psychiatric readmission by two times. Also, alcohol and cannabis abuse/dependence increased the readmission rates by two times but was statistically not significant which correlated with current literature.…”

“…13 So, treating SUDs can reduce readmission rates and so should be included in the risk predictor model. 12 A retrospective study (N = 2443) found that primary diagnosis of bipolar disorder type and/or manic episode does not predict psychiatric readmission. 14 But, in our study, we found that comorbid bipolar disorder in patients with psychotic disorders increases the odds for annual readmission by two times supported by current literature.…”

Substance Use/Dependence in Psychiatric Emergency Setting Leading to Hospitalization: Predictors of Continuity of Care

“…The post-discharge consultation appears to be critical; among patients discharged from residential treatment for substance use, the ones attending their initial outpatient appointment within 7 days of discharge evidenced better long-term outcomes relative to patients who did not, with respect to continuous abstinence [ 6 ]. Building a proper continuity of care would help reduce in-patient readmissions, considering that using substances precisely increases the odds of 30-day all-cause readmission (particularly opioid, cocaine, and amphetamine use) [ 7 ].…”

Predictors of Unplanned Readmissions Among Patients With Substance Use Disorders

“…6 Research found that up to 33% of patients with SUD return to general hospital for all medical reasons combined within 1 month of discharge. 1,2,7 When examining admission for behavioral health reasons 29% of patients with SUD were found to return to hospital after 90 days with the highest number within the first week after discharge. 8 One Swiss study found that 41% of patients with SUD were readmitted to a specialized addiction unit within the year following discharge.…”