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UC index severity score, early readmission predict mortality
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A model stratifying the severity of hospitalization and identify colectomy risks, when used with early hospital readmission, helped predict increased mortality among patients with ulcerative colitis, according to research published in Inflammatory Bowel Diseases.
Anita Afzali, MD, MPH, of the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center, and colleagues wrote that readmissions after IBD-related hospitalizations are common, with a 30-day rate of 7% to 19.1% and a yearly readmission rate of 39%. Additionally, readmissions within 90 days can result in $576 million in excess costs to the health care system.
“The aims of the present study were to determine the rate and causes of readmission, in-hospital mortality and hospital-based health care utilization associated with hospitalization for UC and to use the aforementioned UC severity score as a predictor for 30-day and calendar year readmissions and in-hospital mortality,” they wrote.
Afzali and colleagues analyzed data from 133,819 patients with UC taken from the Nationwide Readmissions Database between 2010 and 2014. Researchers collected patients’ baseline characteristics, surgical rates, readmissions, mortality and hospital outcomes and grouped them based on index severity — low, medium and high. A total of 22,762 patients were readmitted within 30 days (17%).
Investigators found that patients with high-severity presentations had higher surgical rates (31.6% vs. 12.4%), higher 30-day (24.3% vs. 15.6%) and calendar year readmission rates (46% vs. 35.2%), longer length of stay (15.1 days vs. 4.6 days) and increased costs ($31,136 vs. $8,946) compared with patients with low severity (all P < .001). Additionally, high-severity patients had increased index (2.5% vs. 0.4%) and calendar year (2% vs. 0.9%) mortality compared with low-severity patients (both P < .001).
Researchers also found that patients readmitted within 30 days had higher mortality rate (4.5% vs. 0.45%), index surgery rate (19.2% vs. 12.3%), length of stay (6.9 vs. 5.4 days) and hospital costs ($13,530 vs. $10,366) compared with patients not readmitted within 30 days (all P < .001).
Afzali and colleagues wrote that disease severity and early readmission were both tied to adverse outcomes after patients are hospitalized for UC. They called for future studies to validate the severity scoring system and help identify patients early in the process to reduce readmissions.
“Further efforts should emphasize early specialized care in those admitted with worse index severity, as they are at the highest risk of poor outcomes,” they wrote. “Such investigations could include short- and long-term follow-up of these patients to evaluate which strategies demonstrate success.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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