Risk Factors for Rehospitalization Within 90 Days in Patients with Inflammatory Bowel Disease

Abstract

Background Care of patients with inflammatory bowel disease (IBD) poses a significant burden to the health-care system. Repeat hospitalization in subgroups of IBD patients seems to be a large part of this issue; however, there are limited data examining the characteristics of these patients. The aim of this study was to characterize admission patterns in patients with IBD at a tertiary-care center and to identify preventable risk factors of 90-day readmission after an index IBD admission. Methods Retrospective analysis was performed extracting data from an electronic medical record over a 2-year period. Results Three hundred fifty-six patients were admitted at least once during the 2-year study period for an unplanned IBD-related reason. Of these, 48.9% were admitted once, 38.2% were admitted 2 to 4 times, and 12.9% were admitted 5 or more times during the study period. Patients with any admission within 90 days before index were excluded; n = 33. One hundred two patients had experienced a readmission by 90 days after index admission. Numerous demographic and medical factors were examined for association with readmission. The final Cox model included 3 variables: depression (HR = 1.99, 1.33–3.00), chronic pain (HR = 1.88, 1.14–3.10), and steroid use in the previous 6 months (HR = 1.33, 0.92–2.04). Conclusions Our findings suggest that patients with depression and chronic pain are at greatest risk for a readmission within 90 days after an initial IBD admission. Disease activity, represented by steroid use in the previous 6 months, was not related to readmission. Addressing these problems in the outpatient setting may reduce future hospitalizations.

Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

“…Prior single center experiences have reported 90 day readmission rates between 21% and 31% for patients with IBD. 9,28 While the demonstrated rate of readmission in this study was similar, our use of a nationally representative sample is perhaps a more accurate representation of the proportion of patients with UC and CD requiring readmission within 90 days. Additionally, our findings are similar to the rate of readmission within one year reported from an analysis utilizing a Canadian national health database.…”

“…4,9 Small bowel obstruction has been commonly associated with readmission among patients with CD in multiple studies, 4,9,30 and represented 1.7% of readmissions among patients with CD in our population. The association between infectious complications and the need for readmission among patients with IBD is significant, particularly the association between septicemia and both UC and CD readmissions.…”

“…9 Abdominal pain is a common symptom among patients with IBD, 15 and may be associated with IBD-irritable bowel syndrome. 16,17 Although there were no available data on medication use within the NRD, a prior study evaluating narcotic pain use among inpatients with IBD demonstrated that use of narcotic pain medications was not associated with disease severity.…”

“…5–8 The existing literature on IBD readmissions after non-surgical hospitalizations in the US includes single center experiences, where generalizability may be limited. However, these studies have suggested that poorly-controlled pain and depression, 9 and lack of compliance with outpatient follow-up 4 were associated with a higher likelihood of readmission. Prior work has also demonstrated that disease activity was not related to readmission within 90 days, 9 suggesting the role of other, potentially modifiable factors, such as psychiatric disease, tobacco abuse, and chronic pain.…”

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

“…Prior single center studies evaluating adults with IBD have associated an increased risk of hospital readmission with factors such as chronic pain and depression. 16 Both anxiety and depression are increased among patients with IBD compared with other disease states and the general population. 17–19 In addition, anxiety has been associated with worse outcomes among pediatric patients with IBD 20 and increased resource utilization among adult patients with IBD.…”