Risk factors and incidence of 90-day readmission for diverticulitis after an acute diverticulitis index admission
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ORIGINAL ARTICLE
Risk factors and incidence of 90-day readmission for diverticulitis after an acute diverticulitis index admission Debashis Reja 1 & Ilan Weisberg 2 Accepted: 1 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives Acute diverticulitis is the third most frequent cause of gastrointestinal admission in the USA. We sought to determine the incidence of recurrence within a 90-day period and determine its impact on mortality and hospital utilization. Methods Nationwide Readmission Database (NRD) 2016 was used to identify patients ≥ 18 years old with a principal diagnosis of acute diverticulitis who were readmitted for recurrence within 90 days. The primary outcome was 90-day readmission rate for acute diverticulitis, and predictors were analyzed using a multivariate regression analysis. Secondary outcomes were mortality and hospital resource utilization. Results A total of 171,238 admissions were included which met inclusion criteria. Ninety-day readmission for acute diverticulitis after index diverticulitis hospitalization was 8.9%. Readmissions were associated with in-hospital additional total cost of $444,726,560 and 65,685 total hospital days and mortality rate of 4.69% compared with mortality rate of 5.20% on index hospitalization (p < 0.01). In multivariable analysis, increased odds of readmission were associated with disposition against medical advice (OR 1.75, 95% CI 1.31–2.33), younger age (OR 0.98, 95% CI 0.98–0.99), and shorter length of stay (OR 0.99, CI 0.98–0.99). Conclusions Acute diverticulitis is frequently associated with recurrence within 90 days and bears a substantial financial and mortality burden. Targeted interventions are needed to minimize readmissions in identified subpopulations. Keywords Diverticulitis . Readmission . Hospital utilization
Introduction Diverticulitis is the third leading gastrointestinal cause of hospitalization in the USA and is one of the most common gastrointestinal complaints in emergency rooms and outpatient clinics [1, 2]. It is defined as the inflammation of a diverticulum or outpouching of colonic mucosa through muscle at points where blood vessels penetrate the wall [3]. Acute diverticulitis develops in approximately 4 to 15% of patients Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03769-7) contains supplementary material, which is available to authorized users. * Debashis Reja [email protected] 1
Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
2
Department of Gastroenterology, Mount Sinai Beth Israel, New York City, NY 10003, USA
who have diverticulosis [4] with the incidence increasing with age. The mean age upon admission is 63 years [5]. The pathophysiology is believed to be injury to the diverticulum through increased intraluminal pressure or thickened food particles. Complications can include bleeding, bowel obstruction, abscess, phlegmon, fistula, or perforation and can occur in up
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