Citations

Abstract Background/Aim Limited data exists on 30-day readmission rates, readmission causes and predictors following Ischemic Colitis (IC). The aim is to identify etiologies for the above using a national database. Methods A retrospective cohort study using the 2019 National Readmission Database (NRD) of adult patients with an index admission (IA) for IC from January to November and were readmitted within 30 days of discharge was performed. The primary outcome was readmission of any cause. Secondary outcomes were mortality and resource utilization associated with readmission. Independent risk factors for all-cause readmission were identified using Cox regression analysis. Results A total of 6,853 IC patients were identified. Readmission within 30 days occurred in 762 (11%). The primary readmission cause was sepsis. A total of 325 patients died during the IA and additional 30 patients died within 30 days of discharge. Independent predictors of readmission were discharge to short term hospital, a Charlson comorbidity index score ≥ 2 and admission at large size hospital. Having private insurance and undergoing colonoscopy were associated with lower readmission odds. Economic burden of readmission was $12 million in total costs and $51.4 million in total charges. Conclusion Among admitted IC patients, 30-day readmission rate was 11% with half of those secondary to sepsis. Undergoing colonoscopy during the IA is associated with 34% less risk of readmission and disposition to other facilities appears associated with increased early readmission risk. Prospective evaluation to confirm these findings along with development of optimal care strategies to reduce readmission post IC episodes are needed.

e16193 Background: Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) in patients within the Milan criteria. Readmissions are common postoperatively, and can be associated with increased morbidity and healthcare burden. Hence we aim to identify incidence, impact and independent predictors for readmission in patients who underwent LT in HCC. Methods: Retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for LT with an underlying diagnosis of HCC, in patients with cirrhosis we used the BAVENO score to categorize between compensated and decompensated cirrhosis. We aim to identify 30-day readmission rate, mortality, healthcare related utilization resources and independent predictors of readmission. Results: A total of 2,092 patients with HCC underwent liver transplantation. The 30-day readmission rate was 25.6%. Main causes for readmission were post-surgical complications from LT, sepsis, liver failure. Readmitted patients were less likely to have private insurance (40.5% vs 34.5%; P<0.01), to be obese (18.2% vs 7.9%; P<0.01), hypertensive (51.2% vs 39.5%; P<0.01), have history of non-alcoholic steatohepatitis (16.5% vs 2.3%; P<0.01). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P<0.01). The total health care in-hospital economic burden of readmission was $56.1 million in total charges and $15.2 million in total costs. Independent predictors of readmission were type 2 diabetes, transfusion of blood products during index admission, protein-caloric malnutrition, sepsis, and preventive factors were younger age, private insurance and cannabis use. Conclusions: Readmissions after LT in HCC are associated with higher mortality and pose a high health care burden. We identified risk factors that can be targeted to decrease overall patient morbidity, mortality and health care burden.[Table: see text]

e16109 Background: Total gastrectomy with lymph node dissection is curative for early gastric malignancy which accounts for 1.5% of cancer cases in the U.S. Readmissions are common postoperatively, and are associated with increased morbidity, mortality, hospital costs and decreased quality of life. We hence aim to identify incidence, impact and independent predictors for readmission in patients who underwent total gastrectomy in gastric malignancy. Methods: We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for total gastrectomy with a concomitant diagnosis of gastric malignancy. T-test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. ICD 10 codes were used to identify diagnoses and procedures. Results: A total of 1,779 patients with gastric malignancy underwent total gastrectomy. The 30-day readmission rate was 18.5%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Readmitted patients were more likely to be on chemotherapy. (40.1% vs 27.2%; P<0.01) and more likely to be discharged to a skilled facility (13.5% vs 17.9%; P<0.01). The total health care in-hospital economic burden of readmission was $6.5 million in total charges and $25 million in total costs. Independent predictors of readmission were major bleeding, respiratory failure requiring mechanical ventilation, peripheral parenteral nutrition, history of non-alcoholic hepato-steatosis, and prolonged length of stay. Conclusions: Readmissions after gastrectomy in patients with gastric malignancies are associated with lower in-hospital mortality yet pose a substantial economic burden on healthcare. The lower mortality might be explained by the relatively stable course and lower comorbidities of patients who become eligible for discharge after surgery. Further studies are suggested. Modifiable risk factors like malnutrition and sepsis warrant special attention to decrease readmissions and improve overall outcomes.[Table: see text]