Abdul Waheed, MD, Kai Huang, MD, Furqan Haq, PhD, Subhasis Misra, MD, MS, FACS. Brandon Regional Medical Center
Introduction: The diverticular disease accounts for 254,179 inpatient discharges and 1,493,865 outpatient clinic visits in the United States (US) annually. The annual treatment costs in the US for diverticular disease exceed 2.6 billion dollars at an estimated cost per hospitalization of $9,742-$11,729. Up to15-20% of patients with diverticular disease develop acute diverticulitis (AD) which accounts for an annual 80,000 hospitalizations. The Affordable Care Act (ACA) established the hospital readmission reduction program requiring the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions. In the light of ACA, it is imperative to identify high-risk AD patients and provide adequate treatment to prevent readmission. The current study sought to develop a predictive nomogram to identify patients at greatest risk of AD readmission in an effort to develop risk reduction strategies.
Methods: Data of 145,325 admissions for AD was abstracted from the New York and California State In Patient Database (SID). Standard statistical methodology was used to identify risk factors for 60-day AD readmission. A linear regression scale correlating 60-day readmission risk for AD will is provide each patient with a unique readmission score based on risk factors present at the time of index AD admission. The Readmission After Acute Diverticulitis (RAAD) is being devolved and validated to provide each patient with a postoperative readmission risk scale.
Results: Among 145,325 AD patients, 23,742 (16.3%) were readmitted within 60 days. A majority of patients were age >65 years (55.4%), Caucasians (67.9%), female (57%), and had Medicare or Medicaid insurance (61.6%). Mean index hospitalization length was 5.71 days. Fewer patients in the readmission group were age > 65 years (49.6%), females (56.9%), while more were Africa Americans (10.3%), p<0.001. Multivariate analysis identified the following were risk factors for 60-day AD readmission: African American race, Age < 65 years, index discharge to other hospitals and skilled nursing facility, and index discharge against medical advice, p<0.05. Comorbidities which increase the 60-day readmission risk for AD include anemia, rheumatoid arthritis, collagen vascular disease, coagulopathy, diabetes, lymphoma, metastatic cancer, paralysis, peripheral vascular disease, and pulmonary circulation disorders p<0.05.
Conclusion: Although impossible to eliminate all AD readmission, the RAAD score should allow physicians to implement risk modification strategies or consider earlier surgical interventions for certain patients at high AD readmission risk. The implementation of RAAD score will not only reduce healthcare expenditures, it will also improve the current standard of care for these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94240
Program Number: S127
Presentation Session: Colorectal III
Presentation Type: Podium