The Burden of 30-Day Readmission for Gastrointestinal, Pancreatic, and Liver Diseases in the United States: An Opportunity to Innovate, Strategize, and Deliver: 1095

Introduction: Gastrointestinal, pancreatic, and liver (GI) diseases contribute to substantial inpatient morbidity, mortality, and healthcare resource utilization. As a quality indicator, 30-day readmission rates are an important measure for Centers for Medicare/Medicaid Services. We sought to identify the 30-day readmission rates and associated outcomes for the most common GI diseases in the United States. Methods: We performed a cross-sectional analysis of the 2012 Nationwide Inpatient Sample to identify the 13 most common GI diseases. We then queried the 2013 Nationwide Readmission Database with specific ICD-9-CM codes to (a) acquire data on key outcomes of mortality (index admission, overall), hospitalization costs, 30-day readmission and (b) conduct a multivariate analysis for predictors of 30-day readmission. Pearson's correlation (r) was used to determine the significance of association between 30-day readmission and mortality rates. Results: For the year 2013, the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for $ 25 billion (Table 1). The 30-day readmission rates were highest for chronic liver disease (25.4%), C. difficile infection (23.6%), functional/motility disorders (18.5%), inflammatory bowel disease (16.3%), and GI bleeding (15.5%). The highest index (%) and subsequent (%) admission mortality rates for key GI diseases were: chronic liver disease and viral hepatitis (6.1% and 12.6%), C. difficile infection (2.3% and 6.1%), and GI bleeding (2.2% and 5.0%) (Figure 1). Among the leading 13 GI diseases, chronic liver diseases and GI bleeding together contributed to nearly 60% of index hospitalization and readmission-related mortality. 30-day readmission correlated with any subsequent admission moratality (r = 0.80, p = 0.001). Following specific multivariate analysis for each of the disease groups, having Medicare or Medicaid insurances, ≥3 Elixhauser comorbidities, and length of hospital stay > 3 days were significantly associated with 30-day readmission for all the 13 GI disease states.Figure. 30: day readmission rates and associated mortality for the GI diseases with most frequent readmission rates.Table: Analysis of the Nationwide Readmission Database 2013: Most frequent gastrointestinal, pancreatic, and liver diseases as primary diagnoses during index hospitalization. Outcome measures include: mortality (index admission and any subsequent admission), costs, and 30-day readmission rate.Conclusion: Readmissions within 30 days are associated with increased mortality for common GI diseases. While chronic GI disorders account for most frequent 30-day readmissions, a significant opportunity exists to decrease readmission in preventable and non-chronic GI diseases. Targeted research, quality improvement, and preventative healthcare strategies can likely reduce the overall GI disease burden.