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The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease
Edward L Barnes1, Bharati Kochar1, Millie D Long2
1Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Insights
Hospital readmissions are common in pediatric inflammatory bowel disease (IBD) patients, costing millions. For Crohn's disease (CD), anxiety and depression increase readmissions, while surgery decreases them. For ulcerative colitis (UC), longer initial hospital stays raise readmission risk.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Inflammatory Bowel Disease (IBD) Epidemiology
Background:
- Pediatric inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC).
- Hospital readmissions in pediatric IBD patients represent a significant burden on healthcare resources and costs.
- Understanding readmission predictors is crucial for improving patient outcomes and resource allocation.
Purpose of the Study:
- To determine the frequency and economic impact of hospital readmissions in pediatric IBD patients.
- To identify demographic and clinical factors associated with 90-day readmissions in pediatric CD and UC.
- To evaluate the predictors of hospital readmissions in pediatric inflammatory bowel disease.
Main Methods:
- Retrospective cohort study utilizing the 2013 Nationwide Readmissions Database.
- Identification of pediatric patients (<18 years) with CD or UC using ICD-9-CM codes.
- Multivariable logistic regression analysis to identify predictors of readmission, controlling for demographic and hospitalization details.
Main Results:
- A total of 2733 hospitalizations were analyzed, with 22% resulting in readmission within 90 days.
- Readmissions incurred an estimated 11,440 excess hospitalization days and over $107 million in charges.
- For CD, male sex and psychiatric comorbidities (anxiety/depression) increased readmission risk, while surgery decreased it. For UC, index admissions longer than 7 days increased readmission risk.
Conclusions:
- Hospital readmissions are frequent in pediatric IBD, contributing substantially to healthcare costs and resource utilization.
- Psychiatric comorbidities, specifically anxiety and depression, are significant predictors of readmission in pediatric Crohn's disease.
- Optimizing management strategies for pediatric IBD, particularly addressing mental health and length of stay, may reduce readmission rates.
Objective:
To evaluate the burden and predictors of hospital readmissions among pediatric patients with inflammatory bowel disease using the Nationwide Readmissions Database.
Study Design:
We performed a retrospective cohort study using 2013 Nationwide Readmissions Database. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients <18 years with diagnoses of ulcerative colitis (UC) or Crohn's disease (CD). Demographic factors and details of hospitalizations were evaluated using survey procedures in SAS v 9.4 (SAS Institute, Cary, North Carolina). Multivariable logistic regression was used to estimate ORs and 95% CIs of readmission.
Results:
Among 2733 hospitalizations (63% CD, 37% UC), 611 (22%) patients were readmitted within 90 days of the index hospitalization. Readmission resulted in weighted estimates of 11 440 excess days of hospitalization and total charges of over $107 million. For CD, male sex (aOR 1.36, 95% CI 1.03-1.81) and co-existing anxiety or depression (aOR 1.89, 95% CI 1.06-3.40) were associated with increased readmissions, while patients who underwent surgery had decreased readmissions (aOR 0.40, 95% CI 0.24-0.65). In patients with UC, an index admission of >7 days was associated with increased readmissions (aOR 1.69, 95% CI 1.09-2.62).
Conclusions:
Readmission occurs frequently in children with inflammatory bowel disease and is associated with significant cost and resource burdens. Among patients with CD, psychiatric comorbidities such as anxiety and depression are apparent drivers of readmission.
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