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Sunday Poster Session

Category: Colon

P0189 - Colonoscopy for Ischemic Colitis Is Associated With Less Risk of Readmission: A Nationwide Study of 30-Day Readmission Rates, Outcomes, and Predictors

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Luis M. Nieto, MD

WellStar Health System-Cobb Medical Center
Morgantown, WV

Luis M. Nieto, MD¹, Sharon I. Narvaez, MD², John Martinez, MPH², Jami Kinnucan, MD, FACG³, Pedro Palacios, MD³, Steven Keilin, MD⁴
¹WellStar Health System-Cobb Medical Center, Atlanta, GA; ²WellStar Cobb Medical Center, Atlanta, GA; ³Mayo Clinic Florida, Jacksonville, FL; ⁴Emory University School of Medicine, Atlanta, GA

Introduction: Ischemic colitis (IC) is the most common cause of intestinal ischemia and its incidence increases with age and may have a significant representation in morbidity and mortality. There is paucity of data regarding 30-day specific readmission rates, causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission in ischemic colitis.

Methods: Retrospective cohort study using the 2019 National Readmission Database of adult patients that had an index admission (IA) for IC from the month of January to November and were readmitted within 30-days of discharge. ICD-10CM/PCS codes were utilized to identified diagnosis and procedures. The primary outcome was readmission of any cause. Secondary outcomes were mortality, resource utilization (length of stay (LOS), total hospitalization costs and charges) associated with readmission. Independent risk factors for readmission were identified using Cox regression analysis.

Results: A total of 6,853 Ischemic Colitis (IC) patients were identified in 2019. Out of which 762 (11.0%) were readmitted in 30 days. The number one cause of readmission was sepsis. A total of 325 patients died during the IA and additional 30 patients died within 30 days of discharge. The respective mortality rates for IA and readmission were 4.7% and 4.0% (p= 0.79). Readmitted patients had significantly increased LOS (5.7 vs. 6.4 days; p= < 0.01). The total economic burden of readmission was $12 million in total costs and $51.4 million in total charges. Independent predictors of readmission were: patients discharged to short term hospital (aHR:4.54, p= 0.02), nursing skill facility (aHR:1.98, p= < 0.01), and home health care (aHR:2.08, p= < 0.01), a Charlson comorbidity index score ≥ 2 (aHR:1.63, p= 0.02) and being admitted at large size hospital (aHR:1.37, p= 0.04). Having private insurance as primary payer (aHR:0.59, p= < 0.01) and undergoing to colonoscopy (aHR:0.66, p= < 0.01) were associated with lower odds of readmission.

Discussion: 30-day readmission rates after admission for IC are high with 50% of readmissions secondary to sepsis. Undergoing colonoscopy during the IA is associated with 34% less risk of readmission and disposition to other facilities seems to increase the risk of early readmission. Further prospective studies are needed to determine the mechanisms behind these findings and strategies should be carried out to decrease readmission rates.

Independent Predictors of 30-days readmission

Variable

Hazard ratio (95% confidence interval)

P value

Female

0.92 (0.72-1.18)

0.53

Age

0.98 (0.97-1.01)

0.08

Disposition of patient

- Discharged to home or self-care

- Short-term hospital

- Skilled nursing facility/intermediate care

- Home health care

- Against medical advice

Reference

4.54 (1.19-17.30)

1.98 (1.40-2.81)

2.08 (1.55-2.79)

2.37 (0.96-5.81)

Reference

0.02

< 0.01

0.06

Insurance Provider

Medicare

Medicaid

Private

Uninsured

Reference

1.20 (0.77-1.88)

0.59 (0.41-0.87)

0.74 (0.30-1.182)

Reference

0.42

< 0.01

0.51

Median Income in patient zip code

$1 - 42,999

$43,000-53,999

$54,000-70,999

$≥71,000

Reference

0.90 (0.68-1.21)

1.63 (1.07-2.49)

1.79 (1.24-2.59)

Reference

0.46

0.22

< 0.01

Patient residence

- Large metropolitan area with at least 1 million residents

- Small metropolitan areas with less than 1 million residents

- Micropolitan areas

- Not metropolitan or micropolitan (nonurban residual)

Reference

0.91 (0.68-1.21)

0.82 (0.61-1.10)

0.78 (0.57-1.08)

Reference

0.51

0.18

0.14

Charlson Comorbidity Index Score

≥3

Reference

1.15 (0.78-1.69)

1.63 (1.07-2.48)

1.79 (1.24- 2.59)

Reference

0.46

0.02

< 0.01

In-hospital procedures

Colonoscopy

Colectomy

Parenteral nutrition

0.66 (0.53-0.83)

1.29 (0.89-1.88)

1.02 (0.58-1.82)

< 0.01

0.17

0.92

Other Comorbidities

Obesity

Type 2 DM

Alcohol use disorder

History of tobacco use

Opioid use disorder

Vitamin D deficiency

Malnutrition

0.79 (0.58-1.09)

1.22 (0.96-1.55)

1.37 (0.78-2.40)

0.20 (0.26-1.55)

0.48 (0.19-1.16)

1.82 (0.94-3.53)

0.85 (0.59-1.23)

0.15

0.09

0.25

0.12

0.10

0.07

0.40

Hospital bed size

Small

Medium

Large

Reference

1.26 (0.89-1.79)

1.37 (1.01-1.88)

Reference

0.18

0.04

In-hospital Complications

Shock

Mechanical ventilation

1.05 (0.62-1.79)

0.95 (0.48-1.86)

0.85

0.88

Teaching hospital

1.08 (0.83-1.41)

0.54

Disclosures:

Luis Nieto indicated no relevant financial relationships.

Sharon Narvaez indicated no relevant financial relationships.

John Martinez indicated no relevant financial relationships.

Jami Kinnucan: Abbvie – Advisory Committee/Board Member, Consultant. BMS – Advisory Committee/Board Member, Consultant. Fresinius kabi – Advisory Committee/Board Member, Consultant. Janssen – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant.

Pedro Palacios indicated no relevant financial relationships.

Steven Keilin indicated no relevant financial relationships.

Luis M. Nieto, MD¹, Sharon I. Narvaez, MD², John Martinez, MPH², Jami Kinnucan, MD, FACG³, Pedro Palacios, MD³, Steven Keilin, MD⁴. P0189 - Colonoscopy for Ischemic Colitis Is Associated With Less Risk of Readmission: A Nationwide Study of 30-Day Readmission Rates, Outcomes, and Predictors, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.