PMID- 29561353
OWN - NLM
STAT- MEDLINE
DCOM- 20200917
LR  - 20220408
IS  - 1539-2031 (Electronic)
IS  - 0192-0790 (Linking)
VI  - 53
IP  - 8
DP  - 2019 Sep
TI  - Thirty-Day Readmissions After Upper and Lower Gastrointestinal Hemorrhage: A 
      National Perspective in the United States.
PG  - 582-590
LID - 10.1097/MCG.0000000000001020 [doi]
AB  - BACKGROUND: Upper gastrointestinal hemorrhage (UGIH) and lower gastrointestinal 
      hemorrhage (LGIH) are 2 of the most common reasons for hospital admissions across 
      the United States. The 30-day readmission after index admission poses a major 
      burden on the health care infrastructure, and thus, it is important to assess the 
      causes of 30-day readmission for patients with UGIH and LGIH. METHODS: The study 
      cohort was derived from the 2013 National Readmission Database. International 
      Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 
      Volume 3 diagnosis codes were utilized to identify UGIH and LGIH patients from 
      this data set. Patients who were readmitted to the hospital within 30 days within 
      the same calendar year were further analyzed. Categorical variables and 
      continuous variables were assessed by the chi test and the student t test, 
      respectively. The independent predictors of unplanned 30-day readmissions were 
      recognized by multivariate logistic regression, adjusting for stratified cluster 
      design of National Readmission Database. SAS 9.4 (SAS Institute Inc., Cary, NC) 
      was used for data analysis. RESULTS: The number of index admissions identified 
      from the National Readmission Data 2013 were 82,290 for UGIH and 133,114 for 
      LGIH. All-cause 30-day readmission rate for UGIH versus LGIH was 14.6% 
      (readmitted N=12,046; 56.64% age 65 y and above) versus 14.4% (readmitted 
      N=19,128; 70.21% age 65 y and above and 49.61% men). Gastrointestinal causes were 
      most common (33.9% vs. 39.6%), followed by cardiac (13.3% vs. 15.3%), infectious 
      (10.4% vs. 9.1%), and respiratory causes (7.8% vs. 7.1%) for 30-day readmission 
      for UGIH and LGIH. Significant predictors of increased 30-day readmission (odds 
      ratio, 95% confidence interval, P-value) included metastatic disease (2.15, 
      1.75-2.64, P<0.001), discharge against medical advice (1.85, 1.55-2.22, P<0.001), 
      and length of stay >3 days (1.50, 1.38-1.63, P<0.001). Predictors for 30-day 
      readmission for LGIH included metastatic disease (1.75, 1.48-2.06, P<0.001), 
      liver disease (1.59, 1.49-1.71, P<0.001), and drug abuse (1.38, 1.21-1.58, 
      P<0.001). CONCLUSIONS: Most common reason for UGIH and LGIH readmission was 
      related to gastrointestinal disease, followed by cardiac, infectious, and 
      respiratory etiologies. By addressing these etiologies for readmission, it may be 
      possible to reduce adverse outcomes.
FAU - Patel, Smit D
AU  - Patel SD
AD  - Department of Internal Medicine, University of Connecticut, Farmington.
FAU - Desai, Rupak
AU  - Desai R
AD  - Atlanta Veterans Affairs Medical Center, Decatur, GA.
FAU - Patel, Upenkumar
AU  - Patel U
AD  - Public Health, National University, San Diego, CA.
FAU - Singh, Sandeep
AU  - Singh S
AD  - Institute of Human Behavior and Allied Sciences, New Delhi, India.
FAU - Patel, Zinal
AU  - Patel Z
AD  - NYU Winthrop Hospital, Mineola, NY.
FAU - Patel, Neel
AU  - Patel N
AD  - Department of Internal Medicine, Florida International University, Greater Miami, 
      FL.
FAU - Zhang, Allan
AU  - Zhang A
AD  - Department of Internal Medicine, University of Connecticut, Farmington.
FAU - Panwala, Amruta H
AU  - Panwala AH
AD  - Department of Internal Medicine, University of Connecticut, Farmington.
FAU - Khan, Vinshi N
AU  - Khan VN
AD  - Baylor College of Medicine, Houston, TX.
FAU - Singh, Gagandeep
AU  - Singh G
AD  - Saint Francis Hospital, Hartford, CT.
FAU - Shah, Nihar
AU  - Shah N
AD  - Joan C. Edward School of Medicine, Marshall University, Huntington, WV.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Diagnosis-Related Groups/statistics & numerical data
MH  - Female
MH  - Gastrointestinal Hemorrhage/*epidemiology/etiology
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission/*statistics & numerical data
MH  - United States/epidemiology
MH  - Young Adult
EDAT- 2018/03/22 06:00
MHDA- 2020/09/18 06:00
CRDT- 2018/03/22 06:00
PHST- 2018/03/22 06:00 [pubmed]
PHST- 2020/09/18 06:00 [medline]
PHST- 2018/03/22 06:00 [entrez]
AID - 10.1097/MCG.0000000000001020 [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2019 Sep;53(8):582-590. doi: 10.1097/MCG.0000000000001020.