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One in five C. difficile patients re-hospitalized within 30 days
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LAS VEGAS — More than 20% of patients hospitalized with Clostridium difficile infection in the U.S. are readmitted to the hospital within 30 days, according to research presented at ACG 2016. Predictors of readmission for CDI included female sex, renal failure or electrolyte abnormalities, anemia or coagulation defects, and being discharged home rather than another facility.
“C. diff is now the most common health care-associated infection in the United States,” Vijay Dalapathi, MD, from Mount Sinai St. Luke’s and Mount Sinai Roosevelt, said during his presentation. “It comes at an estimate cost of approximately $6.3 billion each year, and starting in 2017, health care-acquired C. diff 30-day readmission penalties will commence under the CMS quality programs.”
As national data on CDI readmission rates are limited, Dalapathi and colleagues evaluated 2013 data from the National Readmission Database to determine CDI rates, 30-day re-hospitalizations, and causes and predictors of re-hospitalization.
Of 38,409 patients hospitalized with a primary diagnosis of CDI, 65% were women, 84% were aged at least 50 years, 45% had Charlson/Deyo Comorbidity Index (CCI) scores of at least two, and about three-quarters were on Medicare or Medicaid.
The 30-day all-cause re-hospitalization rate was 21.3%, and 26.9% of these patients (or 5.7% of the total cohort) were re-hospitalized with CDI. The most common causes of readmission were CDI (26.9%), septicemia (11.5%) and heart failure (3.6%), and almost half of all readmissions were due to infectious etiologies.
Women had a 12% higher risk for re-hospitalization with CDI compared with men (P = .017), and conversely, women had a 16% lower risk for non-CDI re-hospitalization (P < .01).
Additionally, renal failure or electrolyte imbalances increased the risk for CDI readmission by 15% (P = .01), and anemia or coagulation defects increased both the risk for CDI readmission (OR = 1.13; P = .01) and non-CDI readmission (OR = 1.18; P < .01).
Patients who were discharged home had about a 38% higher risk for CDI readmission compared with those who were discharged to other facilities, but location of discharge had no significant effect on non-CDI readmission, Dalapathi said.
Having a CCI score of at least two had no significant effect on CDI readmissions, but was associated with a 90% increased risk for non-CDI re-hospitalization (P < .01).
“As expected, congestive heart failure increased the odds of readmission in the non-C. diff group by about 20%,” Dalapathi noted.
Finally, patients with private primary insurance were less likely to be readmitted compared with Medicare (33%) and Medicaid (34%) patients.
“Some of the other variables that we looked at were obesity, diabetes, congestive heart failure, chronic pulmonary disease and peripheral vascular disease, and all of these had no impact on C. diff readmission,” he said. – by Adam Leitenberger
Reference:
Dalapathi V, et al. Abstract #39. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.
Disclosures: The researchers report no relevant financial disclosures.