Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission:A nationwide analysis

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey

BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.

Utilization of Transthoracic Echocardiography Is Associated with a Decreased 6-month Readmission Rate in Hospitalized Heart Failure:A Propensity Score-matched Analysis

Objective::Repeated hospitalization due to congestion is a characteristic of the whole course of heart failure.Echocardiography can be used to assess cardiac function and volume status.However,whether echocardiography can reduce the rehospitalization rate remains unclear.This study aimed to evaluate the impact of transthoracic echocardiography(TTE)use on readmission rates in hospitalized patients with heart failure.Methods::The study was based on the Zigong heart failure database,which contained information on 2,008 adult patients with heart failure admitted to the Zigong Fourth People’s Hospital(Sichuan Province,China)from December 2016 to June 2019.Patients were divided into 2 groups according to the usage of TTE on the day of hospital admission(TTE group(1,371 patients)and no TTE group(637 patients),respectively).The primary outcome was the 6-month readmission rate.The statistical approaches used included multivariate Cox regression,propensity score analysis,and an inverse probability weighting model to ensure the robustness of the findings.Results::A significant reduction in 6-month readmission rate was observed among the TTE group compared with the no TTE group(hazard ratio=0.60,95%confidence interval(CI)=0.52-0.69,P<0.001).The frequencies of intravenous nitrates,diuretics,and inotropes during hospitalization were significantly higher in the TTE group compared with those in the no TTE group(10.9%vs.8.3%,88.5%vs.86.2%,and 66.9%vs.65.6%,respectively,all P<0.001).The proportion of patients returning to the emergency department within 6 months was significantly lower in the TTE group compared with the no TTE group(35.6%vs.50.3%,P<0.001).Conclusions::Utilization of TEE on admission day was associated with a reduced 6-month readmission rate in hospitalized patients with heart failure.

Correlation of triglyceride total cholesterol body weight index(TCBI)with 6-month readmission rate in patients with heart failure:A cohort study

Background The prevalence of heart failure(HF)appears to be 1%-2%in adults and increases with age,ranging from approximately 1%in those younger than 50 years to 10%in those older than 70 years.Malnutrition is associated with increased mortality and readmission in patients with cardiovascular disease.Triglyceride total cholesterol body weight index(TCBI),which is a new nutritional index,can be used as a useful prognostic index for patients with coronary artery disease or heart failure.The incidence of readmission due to heart failure remains high in patients with heart failure.The purpose of this study was to investigate whether there is a correlation between the TCBI and readmission rate to facilitate the identification of patients with heart failure at high risk of readmission.Methods This study was a retrospective study that included patients with heart failure who were hospitalized at the Zigong Fourth People.s Hospital from December 2016 to June 2019.TCBI=Serum level of triglyceride(TG,mg/dL)×total cholesterol(TC,mg/dL)×body weight(BW,kg)/1000.The 1685 patients were enrolled and divided into three groups as follows according to the tertiles of TCBI:Low TCBI group(TCBI<460,n=562),medium TCBI group(460≤TCBI<806,n=561)and High TCBI group(TCBI≥806,n=562).The endpoint event was the patient.s readmission in 6 months.Multivariate Cox regression analysis was used to assess the independent association between TCBI levels and 6-month readmission rate.The Kaplan-Meier method was used to draw a time-to-event curve.The Log-rank test was used to determine the difference in event rate among the three TCBI groups.Results During 6-month follow-up,a total of 619 patients(36.7%)applied for readmission,and the low TCBI group had the highest 6-month readmission rate(40.9%vs.35.1%vs.34.2%,P=0.039).Kaplan-Meier curves showed the highest readmission rate for patients with low TCBI during the 6-month follow-up(Log-rank test:P=0.044).In the extended multivariate Cox model,the 6-month readmission hazard ratio(HR)for the low TCBI group was stable in all four models(HRs range:1.24-1.26,P<0.05 for all).After adjusted for variables,a 25%higher of 6-month readmission rate could be observed in patients with low TCBI(HR:1.25,95%CI:1.00-1.56,P=0.046).Conclusions TCBI can be used as an objective indicator to assess the nutritional status of patients.In patients with heart failure,there is a correlation between TCBI levels and the 6-month readmission rate.Lower TCBI level is associated with higher 6-month readmission rate.

All-cause hospitalizations for inflammatory bowel diseases:Can the reason for admission provide information on inpatient resource use?A study from a large veteran affairs hospital

Background:Inflammatory bowel diseases(IBDs) are group of chronic inflammatory illnesses with a remitting and relapsing course that may result in appreciable morbidity and high medical costs secondary to repeated hospitalizations.The study's objectives were to identify the reasons for hospitalization among patients with IBDs,and compare inpatient courses and readmission rates for IBD-related admissions versus non-IBD-related admissions.Methods:A retrospective chart review was performed on all patients with IBD admitted to the Minneapolis Veterans Affairs(VA) Medical Center between September 2010 and September 2012.Results:A total of 111 patients with IBD were admitted during the 2-year study period.IBD flares/complications accounted for 36.9% of the index admissions.Atherothrombotic events comprised the second most common cause of admissions(14.4%) in IBD patients.Patients with an index admission directly related to IBD were significantly younger and had developed IBD more recently.Unsurprisingly,the IBD admission group had significantly more gastrointestinal endoscopies and abdominal surgeries,and was more likely to be started on medication for IBD during the index stay.The median length of stay(LOS) for the index hospitalization for an IBD flare or complication was 4(2–8) days compared with 2(1–4) days for the other patients(P=0.001).A smaller percentage of the group admitted for an IBD flare/complication had a shorter ICU stay compared with the other patients(9.8% vs.15.7%,respectively); however,their ICU LOSs tended to be longer(4.5 vs.2.0 days,respectively,P=0.17).Compared to the other admission types,an insignificantly greater percentage of the group whose index admission was related to an IBD flare or complication had at least one readmission within 6 months of discharge(29% versus 21%; P=0.35).The rate of admission was approximately 80% greater in the group whose index admission was related to an IBD flare or complication compared to the other types of admission(rate ratio 1.8,95% confidence interval 0.96 to 3.4),although this difference did not reach statistical significance(P=0.07).Conclusion:Identifying the reasons for the patients' index admission,IBD flares versus all other causes,may provide valuable information concerning admission care and the subsequent admission history.