Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Table 1 Elixhauser comorbidity variables

Comorbidity variables
Paralysis
Other neurological disordersl
Chronic pulmonary disease
Diabetes without chronic complications
Diabetes with chronic complications
Hypothyroidism
Renal failure
Liver disease
Chronic peptic ulcer disease
Human Immunodeficiency Virus or Acquired Immunodeficiency Syndrome
Lymphoma
Metastatic cancer
Solid tumor without metastasis
Rheumatoid arthritis/collagen vascular diseases
Coagulation deficiency
Obesity
Weight loss
Fluid and electrolyte disorders
Blood loss anemia
Deficiency anemias
Alcohol abuse
Drug abuse
Psychosis
Depression
Congestive heart failure
Valvular disease
Pulmonary circulation disorder
Peripheral vascular disorder
Hypertension

Table 2 Patient and hospital characteristics of admissions for the primary diagnosis of gastroparesis (n = 30064), stratified by readmission status, National Readmission Database, 2010-2014

Patient characteristics	30-d readmission
	Non (%)22007 (73.2%)	Yesn (%)8057 (26.8%)	P
Age, mean (SD), yr	50.1 (17.2)	48 (16.3)	< 0.0001
Age category, n (%)			< 0.0001
18-44 yr	8766 (39.8)	3658 (45.4)
> 45 yr	13241 (60.2)	4399 (54.6)
Sex, n (%)			0.1590
Male	5625 (25.6)	2124 (26.4)
Female	16382 (74.4)	5933 (73.6)
Length of stay in days, mean (SD)	4.8 (5.2)	5.6 (6.0)	< 0.0001
Length of stay > 5 d	5843 (26.6)	2734 (33.9)	< 0.0001
Diabetes	4610 (20.9)	1998 (24.8)	< 0.0001
Diabetic ketoacidosis	161 (0.7)	73 (0.9)	0.1270
Enteral feeding tube placement	704 (3.2)	293 (3.6)	0.0605
Jejunostomy	445 (2.0)	168 (2.1)
Gastrostomy	185 (0.8)	84 (1.0)
Both jejunostomy and gastrostomy	74 (0.3)	41 (0.5)
Gastric surgery	495 (2.2)	97 (1.2)	< 0.0001
Partial gastrectomy	231 (1.0)	54 (0.7)
Pyloroplasty	223 ( 1.0)	32 (0.4)
Other (total gastrectomy, pyloromyotomy)	41 (0.2)	11 (0.1)
Total parenteral nutrition	753 (3.4)	380 (4.7)	< 0.0001
Number of Elixhauser comorbidities			< 0.0001
< 4	14302 (65.0)	4562 (56.6)
≥ 4	7705 (35.0)	3495 (43.4)
Elixhauser readmission index	17.6 (13.7)	21.3 (14.6)	< 0.0001
mean (SD)
Total cost for index admission	$10502/$7573	$13126/$7760	< 0.0001
mean/median (IQR)	($4880-$11858)	($4810-$13750)
Primary payer, n (%)1			< 0.0001
Medicare	8855 (40.3)	3335 (41.5)
Medicaid	3770 (17.2)	1811 (22.5)
Private	7039 (32.1)	2108 (26.2)
Self-pay, no charge, other	2285 (10.4)	787 (0.8)
Income quartiles n (%)2			0.1100
1st quartile	6968 (32.2)	2636 (33.3)
2nd quartile	5668 (26.2)	2023 (25.5)
3rd quartile	5029 (23.2)	1882 (23.7)
4th quartile	3970 (18.3)	1386 (7.5)
Discharge disposition, n (%)3			< 0.0001
Discharged home (routine discharge)	18041 (82.0)	6217 (77.2)
Transfer: Short-term hospital	113 (0.5)	45 (0.6)
Transfer: Other type of facility	1184 (5.4)	393 (4.9)
Home health care	2236 (10.2)	1186 (14.7)
Against medical advice	431 (2.0)	216 (2.7)
Hospital characteristics
Hospital control, n (%)			0.0460
Government nonfederal	3014 (13.7)	1070 (13.3)
Private (not-for-profit)	14523 (66.0)	5247 (65.1)
Private investor owned	4470 (20.3)	1740 (21.6)
Bed size, n (%)			0.0070
Small	2115 (9.6)	692 (8.6)
Medium	5577 (25.3)	1993 (24.7)
Large	14315 (65.0)	5372 (66.7)
Teaching status, n (%)			< 0.0001
Metropolitan non-teaching	9204 (41.8)	3379 (41.9)
Metropolitan teaching	10975 (49.9)	4161 (51.6)
Non-metropolitan	1828 (8.3)	517 (6.4)

¹There were 74 records with missing values for payer type;

²Income quartiles are based on median household income by patient ZIP code. There were 502 records with missing values for income quartiles;

³There were 2 missing values for discharge destination.

Table 3 Summary of 30 and 90-d readmissions, underestimation of readmissions, and fragmentation of care in patients hospitalized with gastroparesis, National Readmission Database, 2010-2014

Time	% Readmission (No/total No)	% Underestimation of readmission (No/total No)	% Fragmentation of care (No/total No.)
30-d	26.8% (8057/30064)	22% (1769/8057)	28.1%(2260/ 8057)
90-d	45.6% (11987/26284)	19.5%( 2334/11987)	33.8%( 4049/11987)

Table 4 Association of admission to a non-index hospital during the first readmission (care fragmentation) with in-hospital costs, length of stay, mortality, and 60-d readmission

	30-d first readmission
	Readmission to index hospital	Readmission to non-index hospital	Comparison	P
Total cost for first readmission, mean/median (IQR)	$12311/$7508	$15645/$8598	Difference in cost: 3803$ (2777-4829)1	< 0.0001
	($4659-$13204)	($5281-$15472)
Length of stay in days, mean (SD)	5.8 (6.5)	6.5 (8.2)	Adjusted HR (95%CI): 1.07 (1.01-1.13)2	0.03
In-hospital Mortality	1.30%	1.00%	Adjusted OR (95%CI):	0.84
			0.95 (0.57-1.57)3
60-d readmission	54.60%	55.30%	Adjusted HR (95%CI): 0.99 (0.94-1.06)4	0.99

¹Results from multivariable linear regression including age, sex, and Elixhauser mortality score;

²Results from multivariable proportional hazards model including age, sex, Elixhauser readmission index. The risk predicted in the length of stay analysis is for later discharge from the hospital, HR > 1 indicates increased risk of later discharge;

³Results from multivariable logistic regression model including age, sex, Elixhauser mortality score;

⁴Results from multivariable proportional hazards model including age, sex, Elixhauser readmission index, and discharge disposition. HR: Hazard ratio; CI: Confidence interval; OR: Odds ratio.