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Dual Antiplatelet Therapy and Arteriovenous Malformations Increase 30-Day Readmission Rates for Patients Who Undergo
Marta Arjonilla1, Nimra Hameed2, Antoine Chiu3
1Department of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN.
Insights
Dual antiplatelet therapy (DAPT) and arteriovenous malformations (AVMs) increase the risk of 30-day readmissions after gastrointestinal bleeding (GIB) endoscopy. Identifying these risk factors aids in targeted discharge planning for better patient outcomes.
Area of Science:
- Gastroenterology
- Internal Medicine
- Health Services Research
Background:
- Gastrointestinal bleeding (GIB) causes significant hospitalizations and readmissions.
- Current GIB management faces challenges with high 30-day readmission rates.
- Identifying readmission risk factors is crucial for healthcare systems.
Purpose of the Study:
- To identify risk factors for 30-day readmissions in patients undergoing inpatient endoscopic evaluation for GIB.
- To analyze demographic, clinical, and procedural factors associated with GIB readmissions.
- To inform strategies for reducing readmission rates in GIB patients.
Main Methods:
- Retrospective cohort study of GIB patients hospitalized between November 2018-2019 and November 2020-2021.
- Inclusion of patients under 18 undergoing inpatient GI procedures for overt, occult, or obscure GIB.
- Logistic regression analysis to determine independent risk factors for 30-day readmissions.
Main Results:
- 7.59% of 1147 patients experienced 30-day readmissions for GI-related issues.
- Dual antiplatelet therapy (DAPT) and arteriovenous malformations (AVMs) were significant risk factors.
- DAPT (OR=1.96) and AVMs (OR=2.17) independently predicted 30-day readmissions.
Conclusions:
- DAPT use and AVMs are independently associated with higher 30-day readmission risk after GIB endoscopy.
- Targeted discharge planning and closer follow-up are essential for high-risk GIB patients.
- These interventions can help reduce readmissions and improve patient outcomes.
Background And Aims:
Gastrointestinal bleeding (GIB) is a leading cause of hospital admissions, with over 485,000 hospitalizations annually in the United States and a 30-day readmission rate of 17.4%. Despite advancements in GIB management, readmissions remain a significant burden on the health care system. This study aimed to identify risk factors for 30-day readmissions following inpatient endoscopic evaluation for GIB.
Methods:
A retrospective cohort study was conducted on patients hospitalized for GIB from November 2018 to November 2019 and from November 2020 to November 2021, excluding the COVID-19 peak period. Patients aged younger than 18 undergoing inpatient GI procedures for overt, occult, or obscure GIB were included. Demographics, hemoglobin levels, medications, procedure details, and 30-day readmissions were collected. Univariate and multivariable logistic regression analyses assessed risk factors for readmission, with subgroup analyses for procedures performed for suspected upper and lower GIB.
Results:
Of the 1147 patients in the final analysis, 87 (7.59%) were readmitted within 30 days for GI-related issues. Risk factors for readmission included dual antiplatelet therapy (DAPT) (21.8% vs. 11.1%, P=0.004), arteriovenous malformations (AVMs) (17.2% vs. 7.9%, P=0.003), lower hemoglobin levels before the procedure (8.7 vs. 9.1, P=0.047), and longer hospital stay (6 vs. 5 d, P=0.012). Multivariable logistic regression models identified DAPT (OR=1.96, P=0.019) and AVMs (OR=2.17, P=0.013) as individual risk factors for 30-day readmissions, after controlling for all factors.
Conclusions:
DAPT use and AVMs were independently associated with increased risk of 30-day readmissions following inpatient endoscopy for GIB. These findings highlight the importance of targeted discharge planning and closer follow-up in high-risk populations to reduce readmissions and improve outcomes.
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