Chan L, et al. - This study intended to report the epidemiology of 30-day unplanned readmissions in patients on hemodialysis and, to determine the predictors for readmission, as well concordance of reasons for initial admission and readmission. For this purpose, a national all-payer administrative database was used. A subsequent 30-day unplanned readmission was reported for nearly one-quarter of admissions. In addition, primary diagnoses that were different from initial hospitalization were responsible for most readmissions. Data also reported that a small proportion of patients accounted for a disproportionate number of readmissions.

Methods

• In this retrospective cohort study, researchers identified index admissions and readmission in patients with ESRD on hemodialysis, using the Nationwide Readmission Database from the year 2013.
• Researchers used the Clinical Classification Software to classify admission diagnosis into mutually exclusive clinically meaningful categories and determine concordance of reasons for admission on index hospitalizations and readmissions.
• They also used survey logistic regression to determine predictors of at least one readmission.

Results

• A total of 87,302 (22%) index admissions were documented during 2013, with at least one 30-day unplanned readmission.
• Findings demonstrated that patient and hospital characteristics were statistically different between those with and without readmissions but there were small absolute differences.
• Data revealed that the reported readmission rate was highest for acute myocardial infarction (25%), whereas the lowest readmission rate was for hypertension (20%).
• Researchers also noted that the primary reasons for initial hospitalization and subsequent 30-day readmission were discordant in 80% of admissions.
• They also identified comorbidities related to readmissions: depression (odds ratio, 1.10; 95% confidence interval [95% CI], 1.05 to 1.15; P<0.001), drug abuse (odds ratio, 1.41; 95% CI, 1.31 to 1.51; P<0.001), and discharge against medical advice (odds ratio, 1.57; 95% CI, 1.45 to 1.70; P<0.001).
• In addition, 20% of all readmissions were attributed to a group of high utilizers, which constituted 2% of the population.