Rate of Risk Factors for and Interventions to Reduce Hospital Readmission in Patients With Inflammatory Bowel Diseases

Nghia H. Nguyen, Jejo Koola, Parambir S. Dulai, Larry J. Prokop, William J. Sandborn, Siddharth Singh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background & Aims: We investigated 30- and 90-day rates and causes of, risk factors for, and interventions to reduce hospital readmission in patients who received medical treatment for inflammatory bowel diseases (IBD). Methods: We performed a systematic search of publications through July 1, 2018 for studies of rates of hospital readmission and associated causes and risk factors in patients who received medical treatments for IBD. Our final analysis included 17 cohort studies (6324 patients) of hospitalized adults with IBD who had received medical treatment, along with reported readmission rates with detailed chart review. We performed random effects meta-analysis to estimate 30- and 90-day rates of readmission and identified causes and risk factors associated with readmission. We also performed qualitative analyses of studies that focused on interventions to reduce readmission. Results: Overall, the 30-day rate of readmission was 18.1% (95% CI, 14.4–22.4) and the 90-day rate was 26.0% (95% CI, 22.7–29.6). On meta-regression, studies with higher proportions of patients with ulcerative colitis than Crohn's disease reported higher risks for readmission. Most common reasons for readmission were IBD flare, infection, or complications from unplanned surgeries during hospitalizations. Consistent risk factors for 30-day readmission were admission for pain control (odds ratio [OR], 2.27; 95% CI, 1.69–3.03), need for total parenteral nutrition on discharge (OR, 2.13; 95% CI, 1.36–3.35), and prior or unplanned surgery during admission (OR, 3.11; 95% CI, 2.27–4.25). Only 1 study focused on interventions (specialized inpatient IBD service) to reduce risk of readmission. Conclusions: Overall 30- and 90-day rates of readmission for patients who received medical treatment for IBD are 18.1% and 26.0%, respectively. IBD flares and infections are common reasons for readmission, and inadequate pain control and need for parenteral nutrition were common risk factors. Interventional studies to reduce risk of readmission are needed.

Original languageEnglish (US)
Pages (from-to)1939-1948.e7
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number9
DOIs
StatePublished - Aug 2020

Funding

Conflicts of interest These authors disclose the following: Parambir S. Dulai has received research support from Takeda , AbbVie , Pfizer , Janssen , Buhlmann , ALPCO , Polymedco , and Prometheus ; and consulting fees from Takeda, AbbVie, Pfizer, Janssen, and Robarts Clinical Trials. William J. Sandborn has received research grants from Atlantic Healthcare Limited , Amgen , Genentech , Gilead Sciences , AbbVie, Janssen, Takeda, Lilly , Celgene / Receptos , Pfizer, Prometheus Laboratories; has received consulting fees from AbbVie, Allergan, Amgen, Arena Pharmaceuticals, Avexegen Therapeutics, BeiGene, Boehringer Ingelheim, Celgene, Celltrion, Conatus, Cosmo, Escalier Biosciences, Ferring, Forbion, Genentech, Gilead Sciences, Gossamer Bio, Incyte, Janssen, Kyowa Kirin Pharmaceutical Research, Landos Biopharma, Lilly, Oppilan Pharma, Otsuka, Pfizer, Precision IBD, Progenity, Prometheus Laboratories, Reistone, Ritter Pharmaceuticals, Robarts Clinical Trials (owned by Health Academic Research Trust), Series Therapeutics, Shire, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Takeda, Theravance Biopharma, Tigenix, Tillotts Pharma, UCB Pharma, Ventyx Biosciences, Vimalan Biosciences, and Vivelix Pharmaceuticals; owns stock or stock options from BeiGene, Escalier Biosciences, Gossamer Bio, Oppilan Pharma, Precision IBD, Progenity, Ritter Pharmaceuticals, Ventyx Biosciences, and Vimalan Biosciences; and his spouse has served as a consultant for Spouse: Opthotech and Progenity, owns stock options in Opthotech, Progenity, Oppilan Pharma, Escalier Biosciences, Precision IBD, Ventyx Biosciences, and Vimalan Biosciences, and is an employee of Oppilan Pharma, Escalier Biosciences, Precision IBD, Ventyx Biosciences, and Vimalan Biosciences. Siddharth Singh has received research grants from AbbVie; and consulting fees from AbbVie, Takeda, Pfizer, and AMAG Pharmaceuticals. The remaining authors disclose no conflicts. Conflicts of interest These authors disclose the following: Parambir S. Dulai has received research support from Takeda, AbbVie, Pfizer, Janssen, Buhlmann, ALPCO, Polymedco, and Prometheus; and consulting fees from Takeda, AbbVie, Pfizer, Janssen, and Robarts Clinical Trials. William J. Sandborn has received research grants from Atlantic Healthcare Limited, Amgen, Genentech, Gilead Sciences, AbbVie, Janssen, Takeda, Lilly, Celgene/Receptos, Pfizer, Prometheus Laboratories; has received consulting fees from AbbVie, Allergan, Amgen, Arena Pharmaceuticals, Avexegen Therapeutics, BeiGene, Boehringer Ingelheim, Celgene, Celltrion, Conatus, Cosmo, Escalier Biosciences, Ferring, Forbion, Genentech, Gilead Sciences, Gossamer Bio, Incyte, Janssen, Kyowa Kirin Pharmaceutical Research, Landos Biopharma, Lilly, Oppilan Pharma, Otsuka, Pfizer, Precision IBD, Progenity, Prometheus Laboratories, Reistone, Ritter Pharmaceuticals, Robarts Clinical Trials (owned by Health Academic Research Trust), Series Therapeutics, Shire, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Takeda, Theravance Biopharma, Tigenix, Tillotts Pharma, UCB Pharma, Ventyx Biosciences, Vimalan Biosciences, and Vivelix Pharmaceuticals; owns stock or stock options from BeiGene, Escalier Biosciences, Gossamer Bio, Oppilan Pharma, Precision IBD, Progenity, Ritter Pharmaceuticals, Ventyx Biosciences, and Vimalan Biosciences; and his spouse has served as a consultant for Spouse: Opthotech and Progenity, owns stock options in Opthotech, Progenity, Oppilan Pharma, Escalier Biosciences, Precision IBD, Ventyx Biosciences, and Vimalan Biosciences, and is an employee of Oppilan Pharma, Escalier Biosciences, Precision IBD, Ventyx Biosciences, and Vimalan Biosciences. Siddharth Singh has received research grants from AbbVie; and consulting fees from AbbVie, Takeda, Pfizer, and AMAG Pharmaceuticals. The remaining authors disclose no conflicts.Funding Siddharth Singh is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK117058, the American College of Gastroenterology Junior Faculty Development Award and the Crohn's and Colitis Foundation Career Development Award (#404614). Dr. Nguyen is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number T32DK007202. Dr. Dulai is supported by the American Gastroenterology Association Research Scholar Award.

Keywords

  • Burden
  • CD
  • Population Health
  • UC
  • Value-Based Care

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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