Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis

Patel, Smit; SirDeshpande, Pooja; Desai, Rupak; Desai, Ninad; Mistry, Hemanshi; Patel, Neel; Mansuri, Zeeshan; Gopalkrishnan, Biju; Mehta, Tapan; Mahuwala, Zabeen; Narwal, Priya; Garg, Neeta

doi:10.1016/j.msard.2019.03.012

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…This finding is not unexpected as this ICD chapter contains the diagnoses optic neuritis and benign paroxysmal vertigo, both of which are common in the MS population. (Karatas, 2008;Patel et al, 2019) Hospital admissions due to neoplasms were lower in our MS cohort compared to the matched cohort. The relationship between cancer and multiple sclerosis is complicated and the literature is conflicting.…”

Section: Discussionmentioning

confidence: 58%

Predictors of hospitalization in a Canadian MS population: A matched cohort study

Al-Sakran

Marrie

Blackburn

et al. 2020

Multiple Sclerosis and Related Disorders

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Hospitalizations are the most costly component of healthcare in Canada, and hospitalization rates are higher in the multiple sclerosis (MS) population compared to the general population. This study aimed to examine predictors of hospitalizations in the MS population in Saskatchewan, Canada. Methods: This retrospective cohort study used population-based health administrative data from Saskatchewan, Canada from 1996 to 2016. Subjects with MS were identified using a validated definition (≥3 hospital, physician, or drug claims for MS). Up to five general population controls were identified for each MS case and matched on sex, age, and geographical location. The rate of hospitalizations and reason for admission were determined for each case and control. Negative binomial (hospitalization rate) and binary logistic (reason for admission) regression models fitted with generalized estimating equations were used to test the following potential predictors: sex, age, median household income, calendar year, prior hospitalizations, and comorbidity status. Results: We identified 4,878 MS cases (11,744 hospitalizations), and 23,662 matched controls (32,541 hospitalizations). Higher comorbidity burden, older age, and prior hospital admissions were associated with an increased rate of all-cause hospitalizations for both cohorts. Males were more likely to be hospitalized than females for all-cause (adjusted rate ratio: 1.20; 95% CI: 1.07 -1.34) and MS-specific (adjusted odds ratio: 1.34; 95% CI 1.15 -1.55) hospitalizations. The rate of MS-specific hospitalizations decreased with age, and there was no association with comorbidity or prior hospitalizations. A diagnosis of MS was associated with decreased odds of hospitalization due to neoplasms, diseases of the circulatory system, and mental health and behavioural disorders. Conclusion: Increased age, comorbidity, and prior hospital admissions are predictors of all-cause hospitalizations. Conversely, MS-related hospitalizations decreased as subjects aged, and there was no association with comorbidity. Our results highlight that reasons for hospitalizations can differ by age, and clinicians should consider this when managing patients, as they make efforts to reduce hospitalizations in the MS population.projected to rise to 2 billion by 2030. (Amankwah et al., 2017) Hospitalizations are the most costly component of healthcare resource use, (Jacobs and Noseworthy, 1990) and represent an important aspect of demand on the healthcare system. (Metcalfe et al., 2003;Evans et al., 2012) According to the Andersen behavioral model, the use of healthcare services is driven by enabling factors (e.g. access), predisposing factors (e.g. age, sex), and the need for healthcare (e.g. illness). (Andersen, 2008) While the rates of hospitalizations in both the MS and general population have decreased over the years in Canada, hospitalization rates in the MS population remain higher than in the

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Section: Discussionmentioning

confidence: 58%

Predictors of hospitalization in a Canadian MS population: A matched cohort study

Al-Sakran

Marrie

Blackburn

et al. 2020

Multiple Sclerosis and Related Disorders

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“…Other studies have shown an association with the CCI score and readmission among patients with nonstroke neurological diagnoses, however these studies were larger, older, did not distinguish service lines, or were disease-specific. 24,25 Altogether, in our General Neurology and Epilepsy service populations, high medication burden was common and represented a potential independent marker for readmission risk, to a greater extent than comorbidity burden.…”

Section: Discussionmentioning

confidence: 98%

“…In the general neurology service, we find ICU stay, higher LOS, and index diagnosis of seizure and/or brain tumor were associated with readmissions which likely represent severity of disease and have been shown in other studies 5,7,25,26 We found those with a primary index diagnosis of CNS demyelinating disease were less likely to be in the readmitted group, but this diagnosis group consisted of younger patients (mean 41 years, sd 2.5), which was previously shown to have less readmissions than older patients. 24 Although seizures and epilepsy disorder are a well-known cause of neurologic readmission, 5 specific seizure or epilepsy characteristics, such as seizure frequency or number of antiepileptics that may also have predictive value in readmissions have not been studied. In our epilepsy service, we were able to assess seizure burden and find that those with the highest seizure burden, classified as >8 seizures per month, had trend but not significance toward readmission in adjusted models.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics Associated With Readmission to 3 Neurology Services at an Urban Academic Center

Bondi

Yang

Croll

et al. 2020

The Neurohospitalist

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Background and Purpose: Hospital 30-day readmissions in patients with primary neurological problems are not well characterized. We sought to determine patient characteristics associated with readmission across 3 different inpatient neurology services at New York University Langone Hospital. Methods: We retrospectively reviewed all 30-day readmissions from the General Neurology, Epilepsy, and Stroke services at NYULH Brooklyn and Manhattan campuses from 2016-2017 and compared them to a random sample of non-readmitted neurology patients. We used univariate analyses to compare demographics, clinical characteristics, disease specific metrics, and discharge factors of non-readmitted and readmitted groups and binomial logistic regression to examine specific variables with adjustment for confounders. Results: We included 284 patients with 30-day readmissions and 306 control patients without readmissions matched by discharge location and service. After adjusting for confounders, we found that the following factors were associated with increased readmission risk: a recent hospital encounter increased risk for all services, increased number of medications at discharge, intensive care unit stay, higher length of stay, and prior history of seizure for the General Neurology Service, increased number of medications at discharge for the Epilepsy Service, and active malignancy and higher discharge modified Rankin Scale score for the Stroke Service. Conclusion: This study identifies potential risk factors for readmission in patients across multiple neurology services. Further research is needed to establish whether these risk factors hold across multiple institutions.

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“…One of the only recent studies with detailed MS readmission data found that 30-day all-cause readmission is common in MS patients, at a rate of 10.2%. 10 MS-related admissions remain costly, 11 and readmission cost and length of stay (LOS) in MS patients tend to be even higher than in the initial admission. 10 noted when assessing prevalence of psychiatric comorbidity in MS patients.…”

Section: Introductionmentioning

confidence: 99%

“…10 MS-related admissions remain costly, 11 and readmission cost and length of stay (LOS) in MS patients tend to be even higher than in the initial admission. 10 noted when assessing prevalence of psychiatric comorbidity in MS patients. Only 10 of 118 studies included in a recent MS and psychiatric comorbidity systematic review had a comparator population.…”

Section: Introductionmentioning

confidence: 99%

Depression readmission risk is elevated in multiple sclerosis compared to other chronic illnesses

et al. 2021

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Objective: Assess readmissions for depression or suicide attempt (SA) after MS admission versus other chronic inflammatory illnesses. Methods: This retrospective cohort study identified MS, asthma, rheumatoid arthritis (RA), depression, and SA in the 2013 National Readmissions Database by International Classification of Diseases codes. Index admissions (MS, n = 7698; asthma, n = 93,590; RA, n = 3685) and depression or SA readmission rates were analyzed. Hazard ratios (HRs) estimated 1-year depression/SA readmission hazard, comparing MS to asthma or RA, adjusting for age, sex, psychiatric comorbidity, substance abuse, tobacco use, income, and index hospitalization characteristics. Results: MS had more baseline depression (24.7%) versus asthma (15.6%) and RA (14.6%). Ninety-day depression readmission rate was higher in MS (0.5%) than asthma (0.3%) and RA (0.03%). Depression readmission HR was higher after MS admission versus asthma (HR = 1.37, 95% confidence interval (CI) = 1.00–1.86, p = 0.0485) and RA (HR = 4.68, 95% CI = 1.60–13.62, p = 0.0047). HR was not different for SA readmission across groups. Depression readmission HR was more than double in MS patients with psychiatric disease or substance abuse versus RA or asthma patients with either comorbidity. Conclusion: Depression readmission risk after MS hospitalization was elevated versus asthma/RA. Substance use and baseline psychiatric comorbidity were more strongly associated with depression readmission in MS patients.

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Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis

Cited by 14 publications

References 25 publications

Predictors of hospitalization in a Canadian MS population: A matched cohort study

Predictors of hospitalization in a Canadian MS population: A matched cohort study

Patient Characteristics Associated With Readmission to 3 Neurology Services at an Urban Academic Center

Depression readmission risk is elevated in multiple sclerosis compared to other chronic illnesses

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