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Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

Barnes, Edward L. MD, MPH*; Kochar, Bharati MD*; Long, Millie D. MD, MPH*,†; Kappelman, Michael D. MD, MPH*,†; Martin, Christopher F. MSPH*,†; Korzenik, Joshua R. MD; Crockett, Seth D. MD, MPH*,†

doi: 10.1097/MIB.0000000000001121
IBD LIVE Articles

Background: Previous studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBDs). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors.

Methods: We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis or Crohn's disease and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidities during index admission. Logistic regression was used to estimate factors associated with hospital readmission.

Results: Among 52,498 hospitalizations of patients with IBD (63% Crohn's disease and 37% ulcerative colitis), 12,407 (24%) were readmitted within 90 days of the index hospitalization, resulting in roughly $576 million in excess charges. In multivariable analysis of patients with Crohn's disease, anxiety (odds ratio [OR] 1.31, 95% confidence interval [CI], 1.21–1.43), depression (OR 1.27, 95% CI, 1.07–1.50), chronic pain (OR 1.31, 95% CI, 1.18–1.46), and tobacco abuse (OR 1.13, 95% CI, 1.06–1.22) were associated with a significant increase in odds of readmission. Among patients with ulcerative colitis, anxiety (OR 1.28, 95% CI, 1.14–1.45), depression (OR 1.35, 95% CI, 1.07–1.70), and chronic pain (OR 1.44, 95% CI, 1.21–1.73) were associated with a significant increase in odds of readmission.

Conclusions: Readmission occurs frequently in patients with IBD and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90-day hospital readmission in this population.

Article first published online 19 April 2017.

*Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and

Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

Address correspondence to: Edward L. Barnes, MD, MPH, 130 Mason Farm Road, Bioinformatics Building, CB #7080, Chapel Hill, NC 27599-7080 (e-mail: edward_barnes@med.unc.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

B. Kochar is supported by the National Institutes of Health [T32DK07634]. S. D. Crockett's effort was supported in part, by the National Institutes of Health [KL2-RR025746].

M. D. Long is a consultant for AbbVie, Takeda, Pfizer, and Theravance. The remaining authors have no conflict of interest to disclose.

Received January 11, 2017

Accepted March 9, 2017

© Crohn's & Colitis Foundation
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