Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 22, 2022; 13(3): 85-95
Published online May 22, 2022. doi: 10.4291/wjgp.v13.i3.85
Increasing thirty-day readmissions of Crohn’s disease and ulcerative colitis in the United States: A national dilemma
Dushyant Singh Dahiya, Abhilash Perisetti, Asim Kichloo, Amandeep Singh, Hemant Goyal, Laura Rotundo, Madhu Vennikandam, Hafeez Shaka, Gurdeep Singh, Jagmeet Singh, Sailaja Pisipati, Mohammad Al-Haddad, Madhusudhan R Sanaka, Sumant Inamdar
Dushyant Singh Dahiya, Asim Kichloo, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
Abhilash Perisetti, Division of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
Amandeep Singh, Madhusudhan R Sanaka, Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Hemant Goyal, Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
Hemant Goyal, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, United States
Laura Rotundo, Section of Digestive Diseases, Yale New Haven Hospital, New Haven, CT 06510, United States
Madhu Vennikandam, Department of Gastroenterology and Hepatology, Sparrow Hospital/Michigan State University College of Human Medicine, Lansing, MI 48912, United States
Hafeez Shaka, Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
Gurdeep Singh, Department of Internal Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, NY 13905, United States
Jagmeet Singh, Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Sailaja Pisipati, Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ 85259, United States
Mohammad Al-Haddad, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Sumant Inamdar, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Dahiya DS, Kichloo A and Sumant Inamdar S contributed to the conception and design; Dahiya DS, Kichloo A, Al-Haddad M contributed to the administrative support; Kichloo A and Shaka H contributed to the provision, collection, and assembly of data; Dahiya DS, Perisetti A, Singh A, Al-Haddad M, Sanaka MR and Sumant Inamdar S revised the key components of manuscript; and All authors reviewed the literature, drafted the manuscript, finally approved the manuscript, and agreement to be accountable for all aspects of the work.
Institutional review board statement: As the National Readmission Database does not contain patient-specific and hospital-specific identifiers, this study was exempt from the Institutional Review Boards (IRB) as per guidelines put forth by the IRB for research on database studies.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that was obtained after analysis of a national database.
Conflict-of-interest statement: All authors have no financial relationships to disclose.
Data sharing statement: The NIS database can be accessed at https://www.hcup-us.ahrq.gov. No additional data is available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Department of Internal Medicine, Central Michigan University College of Medicine, 1015 S Washington Ave, Saginaw, MI 48601, United States. dush.dahiya@gmail.com
Received: December 10, 2021
Peer-review started: December 10, 2021
First decision: February 15, 2022
Revised: February 20, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 22, 2022
Processing time: 158 Days and 16.8 Hours
Abstract
BACKGROUND

The prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.

AIM

To identify trends and adverse outcomes for 30 d readmissions for CD and UC.

METHODS

This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant.

RESULTS

Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions.

CONCLUSION

There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Readmissions; Trends

Core Tip: This retrospective interrupted trend study analyzed 30 d readmissions of Crohn’s disease (CD) and ulcerative colitis (UC) in the United States from 2010–2018. There was a rising trend for 30 d all-cause readmission rate of CD and UC, and CD- and UC-specific readmission rate throughout the study period. However, we noted no change in the risk adjusted trends of inpatient mortality and mean length of hospital stay (LOS) for 30 d readmissions of CD and UC. Furthermore, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions.