Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.141
Peer-review started: November 12, 2020
First decision: December 12, 2020
Revised: December 24, 2020
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: February 27, 2021
Gastrointestinal (GI) and liver diseases contribute to substantial inpatient morbidity, mortality, and healthcare resource utilization. Finding ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial importance. Thirty-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI ailments.
To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United States.
A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI diseases. The 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcomes were mortality (index admission, calendar-year), hospitalization costs, and thirty-day readmission and secondary outcomes were predictors of thirty-day readmission.
For the year 2013, the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about $25 billion. The thirty-day readmission rates were highest for chronic liver disease (25.4%), Clostridium difficile (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 calendar-year hospitalization mortality rates were chronic liver disease (6.1% and 12.6%), C. difficile infection (2.3% and 6.1%), and GI bleeding (2.2% and 5.0%), respectively. Thirty-day readmission correlated with any subsequent admission mortality (r = 0.798, P = 0.001). Medicare/Medicaid insurances, ≥ 3 Elixhauser comorbidities, and length of stay > 3 d were significantly associated with thirty-day readmission for all the thirteen GI diseases.
Preventable and non-chronic GI disease contributed to a significant economic and health burden comparable to chronic GI conditions, providing a window of opportunity for improving healthcare delivery in reducing its burden.
Core Tip: Using the 2013 Nationwide Readmission Database, we sought to elucidate the hospital outcomes, including hospitalization costs, mortality rates, readmission rates, and factors contributing to readmission for the 13 most common gastrointestinal (GI)-related diseases. The results of our study highlight the large economic and healthcare burden for these 13 GI-related diseases and identify factors associated with early readmissions. Our study also reveals that preventable and non-chronic GI diseases such as Clostridium difficile, GI hemorrhage, and acute pancreatitis contribute a significant proportion of the overall costs, mortality, and readmission burden. Our data underscore a crucial opportunity for providers to aim at targeting preemptive care to reduce the initial and subsequent readmissions for these preventable GI-related diseases.