Risk factors for 90-day readmission in veterans with inflammatory bowel disease—Does post-discharge follow-up matter?

Abstract

BackgroundRepeat hospitalizations in veterans with inflammatory bowel disease (IBD) are understudied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.MethodsA retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center (MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.ResultsThere were 130 unique patients (56.9% with Crohn’s disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8 ± 15.2 years. The median time to re-hospitalization was 26 days (IQR 10-49), with 30- and 90-day readmission rates of 17.3% (35/202) and 29.2% (59/202), respectively. Reasons for all-cause readmission were IBD-related (71.2%), scheduled surgery (3.4%) and non-gastrointestinal causes (25.4%). The following reasons were independently associated with 90-day readmission: Crohn’s disease (OR 3.90; 95% CI 1.82-8.90), use of antidepressants (OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician (PCP) (OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist (GI) (OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.ConclusionsEarly readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn’s disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.

Nationwide improvement in outcomes of emergency admission for ulcerative colitis in England, 2005‐2013

“…Future quality improvement activities need to include standards for aftercare in the immediate post‐discharge period to reduce avoidable readmissions. In a study of repeat hospitalizations in veterans with IBD, lack of an elective follow‐up visit after discharge was an independent risk factor for 90‐day readmission . The UK IBD Audit did not include any process measures relating to early post‐discharge review.…”

Epidemiology and Risk Factors for Hospitalization in Patients with Ulcerative Colitis and Crohn’s Disease

“…In a study of US veterans looking at readmission rates between 2007 and 2013, the 30-day readmission rate was 17.3%, and the 90-day readmission rate was 29.2%. Patients with CD had a higher risk of readmission than UC patients (OR 3.90, 95% CI 1.82-8.90) [26]. For IBD readmissions, predictors that have been reported include opioid use disorder, younger age, mood disorder (depression and/or anxiety), and lack of follow-up visit after hospitalization [26][27][28][29].…”

Tanshinone IIA attenuates AOM/DSS-induced colorectal tumorigenesis in mice via inhibition of intestinal inflammation

“…Chronic intestinal inflammation is increasingly recognised due to its implication in the pathogenesis of CRC, which may induce the neoplastic transformation of colonic epithelial cells, promoting cellular proliferation and invasiveness, leading to the infiltration of immune cells and soluble mediators, which eventually provides a favourable microenvironment for tumour initiation and development (Park and Kim 2018;Pejin et al 2017). Accumulating evidence has revealed that patients with inflammatory bowel disease (IBD) are at a high risk of developing CRC (Malhotra et al 2018;Zhou et al 2019). CRC patients are mainly treated with surgery supplemented with other therapeutic options, such as chemotherapy and radiotherapy (Johnson et al 2013;Ganesh et al 2019).…”