Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

AIMTo evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis. METHODSWe identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database, which captures statewide readmissions.We excluded patients who died during the hospitalization, and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital (i.e. , different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission, Retrospective Studyhospitalization cost, length of stay, and rates of 60-d readmission were compared between those with and without care fragmentation. RESULTSThere were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%, respectively.Younger age, male patient, diabetes, parenteral nutrition, ≥ 4 Elixhauser comorbidities, longer hospital stay (> 5 d), large and metropolitan hospital, and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery, routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%, respectively.Younger age, longer hospital stay (> 5 d), self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes, enteral tube placement, parenteral nutrition, large metropolitan hospital, and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay (6.5 vs 5.8 d, P = 0.03), and higher mean hospitalization cost ($15645 vs $12311, P < 0.0001), compared to those readmitted to the index hospital.There were no differences in mortality (1.0% vs 1.3%, P = 0.84), and 60-d readmission rate (55.3% vs 54.6%, P = 0.99) between the two groups. CONCLUSIONSeveral factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.