Impact of Readmission for Variceal Upper Gastrointestinal Bleeding: A Nationwide Analysis

摘要

Background Variceal upper gastrointestinal bleeding (VUGIB) is a common and potentially lethal complication of cirrhosis. Population-based data regarding hospital readmission and other outcomes in VUGIB are limited. Aim In a large United States database of patients with VUGIB, we evaluated readmission rates, mortality rates, healthcare resource consumption, and identified predictors of readmission. Methods The 2017 Nationwide Readmission Database using ICD-10 codes was used to identify all adult patients admitted for VUGIB. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality, healthcare resource consumption, and predictors of readmission. Multivariate regression analysis was used to adjust for potential confounders. Results In 2017, there were 26,498 patients with VUGIB discharged from their index hospitalization, and 24.7 were readmitted (all-cause) within 30-days and 41.5 within 90-days. Recurrent VUGIB accounted for 26.7 and 28.9 of 30- and 90-day readmissions, respectively. Compared to index admissions, 30-day readmissions were associated with higher mortality (4.3 vs. 6.4, p < 0.01), increased mean hospital length of stay (5.6 days vs. 4.5 days, p < 0.01), and charges ($65,984 vs. $53,784, p < 0.01), with similar findings in 90-day readmissions. Factors associated with 30-day readmission included end-stage renal disease (HR 1.2, p < 0.05), chronic kidney disease (HR 1.31, p < 0.01), and acute kidney injury (HR 1.14, p < 0.05). Conclusion Based on a nationwide cohort of hospitalized VUGIB patients, 25 were readmitted within 30-days and 42 within 90-days. Readmission was associated with increased mortality and healthcare consumption compared to the index admission. Additionally, acute and chronic renal injury were predictors of patients at high-risk for readmission.