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Thirty-Day Readmissions After Upper and Lower Gastrointestinal Hemorrhage

A National Perspective in the United States

Patel, Smit D. MD, MPH*; Desai, Rupak MBBS; Patel, Upenkumar MBBS, MPH; Singh, Sandeep MBBS§; Patel, Zinal MD; Patel, Neel MBBS; Zhang, Allan DO*; Panwala, Amruta H. MD*; Khan, Vinshi N. MD#; Singh, Gagandeep MD**; Shah, Nihar MD, FACP††

Journal of Clinical Gastroenterology: September 2019 - Volume 53 - Issue 8 - p 582–590
doi: 10.1097/MCG.0000000000001020
ALIMENTARY TRACT: Original Articles

Background: Upper gastrointestinal hemorrhage (UGIH) and lower gastrointestinal hemorrhage (LGIH) are 2 of the most common reasons for hospital admissions across the United States. The 30-day readmission after index admission poses a major burden on the health care infrastructure, and thus, it is important to assess the causes of 30-day readmission for patients with UGIH and LGIH.

Methods: The study cohort was derived from the 2013 National Readmission Database. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volume 3 diagnosis codes were utilized to identify UGIH and LGIH patients from this data set. Patients who were readmitted to the hospital within 30 days within the same calendar year were further analyzed. Categorical variables and continuous variables were assessed by the χ2 test and the student t test, respectively. The independent predictors of unplanned 30-day readmissions were recognized by multivariate logistic regression, adjusting for stratified cluster design of National Readmission Database. SAS 9.4 (SAS Institute Inc., Cary, NC) was used for data analysis.

Results: The number of index admissions identified from the National Readmission Data 2013 were 82,290 for UGIH and 133,114 for LGIH. All-cause 30-day readmission rate for UGIH versus LGIH was 14.6% (readmitted N=12,046; 56.64% age 65 y and above) versus 14.4% (readmitted N=19,128; 70.21% age 65 y and above and 49.61% men). Gastrointestinal causes were most common (33.9% vs. 39.6%), followed by cardiac (13.3% vs. 15.3%), infectious (10.4% vs. 9.1%), and respiratory causes (7.8% vs. 7.1%) for 30-day readmission for UGIH and LGIH. Significant predictors of increased 30-day readmission (odds ratio, 95% confidence interval, P-value) included metastatic disease (2.15, 1.75-2.64, P<0.001), discharge against medical advice (1.85, 1.55-2.22, P<0.001), and length of stay >3 days (1.50, 1.38-1.63, P<0.001). Predictors for 30-day readmission for LGIH included metastatic disease (1.75, 1.48-2.06, P<0.001), liver disease (1.59, 1.49-1.71, P<0.001), and drug abuse (1.38, 1.21-1.58, P<0.001).

Conclusions: Most common reason for UGIH and LGIH readmission was related to gastrointestinal disease, followed by cardiac, infectious, and respiratory etiologies. By addressing these etiologies for readmission, it may be possible to reduce adverse outcomes.

*Department of Internal Medicine, University of Connecticut, Farmington

**Saint Francis Hospital, Hartford, CT

Atlanta Veterans Affairs Medical Center, Decatur, GA

Public Health, National University, San Diego, CA

NYU Winthrop Hospital, Mineola, NY

Department of Internal Medicine, Florida International University, Greater Miami, FL

#Baylor College of Medicine, Houston, TX

††Joan C. Edward School of Medicine, Marshall University, Huntington, WV

§Institute of Human Behavior and Allied Sciences, New Delhi, India

The authors declare that they have nothing to disclose.

Address correspondence to: Smit D. Patel, MD, MPH, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030 (e-mail:

Received November 29, 2017

Accepted February 2, 2018

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