Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 200-209
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.200
Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis
Emad Qayed, Mayssan Muftah
Emad Qayed, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
Emad Qayed, Department of Gastroenterology, Grady Memorial Hospital, Atlanta, GA 30303, United States
Mayssan Muftah, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, United States
Author contributions: Qayed E designed the research, analyzed the data, drafted and revised the manuscript; Muftah M drafted and revised the manuscript; all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and deemed exempt from review by the Emory University Institutional Review Board because the database is publicly available and does not contain any identifiable information that can be linked to any specific subject.
Informed consent statement: Informed consent was not required as this research involves an administrative database and does not contain any identifiable information that can be linked to any specific subject.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Emad Qayed, MD, MPH, FACG, Assistant Professor, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 49 Jesse Hill Jr Street, Atlanta, GA 30303, United States. eqayed@emory.edu
Telephone: +1-404-7781685 Fax: +1-404-7781681
Received: February 20, 2018
Peer-review started: February 20, 2018
First decision: March 9, 2018
Revised: March 12, 2018
Accepted: April 2, 2018
Article in press: April 2, 2018
Published online: September 16, 2018
Processing time: 208 Days and 13.2 Hours
ARTICLE HIGHLIGHTS
Research background

Gastroparesis is a chronic disorder that can lead to debilitating symptoms resulting in recurrent hospitalizations. These hospital admissions can be costly, especially if the patient is admitted repeatedly to different hospitals. Hospital readmissions can be underestimated if non-index readmissions (i.e., readmissions to a different hospital) are not captured during follow up.

Research motivation

Knowledge of the predictors of hospital readmissions can help design interventions that focus on high risk factors. Estimating the rate of care fragmentation provides further insight into the burden of gastroparesis on patients and the healthcare system. It also highlights the need to refine the methods to calculate hospital readmission.

Research motivation

The study aims to evaluate the rate of hospital readmissions in gastroparesis, and to estimate the proportion of readmissions to index and non-index hospitals (care fragmentation). We also sought to study factors related to readmission and care fragmentation, and their effect on future outcomes such as length of stay, costs, mortality, and readmissions.

Research methods

We used the national readmission database to identify all adult admissions with primary diagnosis of gastroparesis. We calculated the rate of 30 and 90-d statewide hospital readmissions and care fragmentation. We analyzed factors related to hospital readmission and care fragmentation using multivariable models.

Research results

We found a high rate of hospital readmission in gastroparesis (26.8% at 30 d and 45.6% at 90 d). Around one fourth of readmissions occur at a different hospital, and 20% occur exclusively at a different hospital. This means that 20% of all 30-d readmissions will not get captured if local hospital databases are used to track patients. Readmission to a different hospital within 30-d was associated with higher hospitalization costs and length of stay. We identified several sociodemographic and clinical factors that are associated with hospital readmission and care fragmentation. Gastric surgery is associated with decreased risk of readmission, while enteral tube insertions (gastrostomy or jejunostomy) did not affect readmissions.

Research conclusions

This is the first population based study to highlight the high rate of hospital readmission and care fragmentation in gastroparesis. It is also the first to report several sociodemographic and clinical factors related to these outcomes, which can be used to identify high-risk patients.

Research perspectives

In addition to reducing hospital readmissions, hospitals should also attempt to decrease care fragmentation because it is associated with increased costs of care. Hospital readmissions are a major cause of morbidity in gastroparesis. Trials involving different interventions for gastroparesis should also evaluate the effect of these interventions on reducing hospital readmissions.