Lindsay Sobotka

Hospital-Acquired Conditions Are Associated with Worse Outcomes in Crohn’s Disease-Related Hospitalizations

BackgroundCrohn’s disease (CD) is a chronically relapsing condition that frequently requires hospitalization. In 2008, the Centers for Medicare and Medicaid Services selected ten conditions that were deemed healthcare-acquired conditions (HACs). Costs related to HACs are not reimbursed as they are considered to be preventable.AimTo determine the prevalence and impact of HACs on hospital outcomes of hospitalized CD patients.MethodsThis was a cross-sectional study using data from the Nationwide Inpatient Sample between 2007 and 2011 with an extended time frame between 2002 and 2013 to specifically evaluate the prevalence of HACs. CD-related hospitalizations and HACs were identified using International Classification of Diseases, Ninth revision, Clinical modification codes. The trend of HACs between 2002 and 2013 was assessed using a Cochran–Armitage test. Primary outcomes, including hospital mortality, length of stay, and hospital charges, were analyzed using univariate and multivariate analyses.ResultsThe prevalence of HACs initially increased between 2002 and 2008, remained stable between 2008 and 2011, than significantly decreased from 2011 to 2013. CD patients with HACs had higher hospital mortality, prolonged LOS, and higher hospital charges compared to patients without HACs.ConclusionsThe prevalence of HACs among hospitalized CD patients initially increased from 2002 to 2008; however, rates began to decrease between 2011 and 2013. In addition, HACs were associated with worse healthcare outcomes in hospitalized CD patients.

Early Sigmoidoscopy or Colonoscopy Is Associated With Improved Hospital Outcomes in Ulcerative Colitis-Related Hospitalization

OBJECTIVES: Performing a sigmoidoscopy or colonoscopy is recommended for assessment of disease activity, excluding infection, and guiding medical treatment during ulcerative colitis (UC)‐related hospitalizations. However, it is unknown whether the timing of endoscopy impacts clinical outcomes. The objective of our study was to determine the impact of timing of endoscopy on hospital outcomes in patients with UC‐related hospitalizations. METHODS: This is a cross‐sectional study using data from the Nationwide Inpatient Sample database (2006–2013). Adult inpatients (≥19 years) with UC‐related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification codes (ICD‐9‐CM). Hospital outcomes stratified by disease severity were compared between patients receiving early (<3 days after admission) and delayed endoscopies (between 3 and 7 days after admission). The primary clinical outcomes included mortality, frequency of large intestine surgery, length of stay (LOS), and hospital cost. Results were analyzed using univariate and multivariate analyses. RESULTS: Of a total of 84,359 patients with UC‐related hospitalizations, 67.2% (56,657) underwent an early endoscopy and 32.8% (27,702) underwent a delayed endoscopy. Delayed endoscopy was associated with higher mortality (adjusted odds ratio: 1.76 (95% confidence interval (CI): 1.08, 2.88)), prolonged LOS (adjusted coefficient: 2.69 (95% CI: 2.61, 2.77)), and higher hospital cost (adjusted coefficient:

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

3,394 (95% CI: 3,234, 3,554)). In UC patients with intermediate disease severity, delayed endoscopy was associated with an increased frequency of large intestine surgery (adjusted odds ratio: 1.60 (95% CI: 1.01, 2.53)). CONCLUSIONS: In UC‐related hospitalizations, the timing of endoscopic procedures impacts outcomes. Early endoscopy is associated with decreased mortality and better health‐care utilization (LOS and hospital cost) compared with delayed endoscopy. In UC patients with intermediate disease severity, early endoscopy is also associated with a decreased frequency of large intestine surgery.

Patients From Appalachia Have Reduced Access to Liver Transplantation After Wait-Listing

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites. METHODS A retrospective analysis of the nationwide readmission database (NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission. RESULTS Of the 59597 patients included in this study, 18319 (31%) were readmitted within 30 d. Majority (58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832 (50%) patients on index admission. Independent predictors of 30-d readmission included age < 40 (OR: 1.39; CI: 1.19-1.64), age 40-64 (OR: 1.19; CI: 1.09-1.30), Medicaid (OR: 1.21; CI: 1.04-1.41) and Medicare coverage (OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity (OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis (OR: 1.16; CI: 1.10-1.23), paracentesis on index admission (OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma (OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted (P-value: 0.34); however cost of care was significantly more on 30 d readmission (

Geographical differences exist in high-value care delivery for inpatient management of cirrhosis: Cost conscious care in cirrhosis: Cost conscious care in cirrhosis

30959 ± 762) as compared to index admission (

Disparities in the Treatment of Hepatocellular Carcinoma Based on Geographical Region Are Decreasing: Disparities in the Treatment of Hepatocellular Carcinoma Based on Geographical Region Are Decreasing

12403 ± 378), P-value: < 0.001. CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

A risk score model of 30-day readmission in ulcerative colitis after colectomy or proctectomy

Background: The Appalachian region is medically underserved and characterized by high morbidity and mortality. We investigated disparities among patients listed for liver transplantation (LT) in wait-list outcomes, according to residence in the Appalachian region. Methods: Data on adult patients listed for LT were obtained from the United Network for Organ Sharing for July 2013 to December 2015. Wait-list outcomes were compared using cause-specific hazard models by region of residence (Appalachian vs non-Appalachian) among patients listed at centers serving Appalachia. Posttransplant patient and graft survival were also compared. The study included 1835 LT candidates from Appalachia and 5200 from non-Appalachian regions, of whom 1016 patients experienced wait-list mortality or were delisted; 3505 received liver transplants. Results: In multivariable analyses, patients from Appalachia were less likely to receive LT (hazard ratio [HR] = 0.86; 95% confidence interval [CI]: 0.79-0.93; P < .001), but Appalachian residence was not associated with wait-list mortality or delisting (HR = 1.03; 95% CI: 0.89-1.18; P = .696). Among liver transplant recipients, patient and graft survival did not differ by Appalachian versus non-Appalachian residence. Conclusion: Appalachian residence was associated with lower access to transplantation after listing for LT. This geographic disparity should be addressed in the current debate over reforming donor liver allocation and patient priority for LT.

Women receive more inpatient resections and ablations for hepatocellular carcinoma than men

The United States spends more money per person on health care than any other country in the world. Patients with cirrhosis are at an increased risk of health‐care utilization. The aim of this study is to evaluate differences in health‐care utilization based on the region of treatment during the inpatient management of patients with cirrhosis.

An Unusual Finding During Evaluation for Dysphagia

Geographic differences have existed in the management of hepatocellular carcinoma (HCC), and efforts to reduce regional disparities have been initiated. The aim of this study is to use the Nationwide Inpatient Sample to determine if regional disparities in the treatment of HCC continue to exist.

Disparities in the Treatment of Hepatocellular Carcinoma based on Geographical Region are Decreasing

Introduction: The Center for Medicare and Medicaid Services established 30‐day readmission rate as a key metric in measuring high‐value, cost‐conscious care; therefore, our aim is to develop a risk score for 30‐day readmission in ulcerative colitis (UC) patients undergoing colectomy or proctectomy. Methods: This study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant user file (2011–2015). Patients with UC undergoing colectomy or proctectomy were identified using ICD‐9, 10, and CPT codes. Stepwise multivariate analyses were used to determine risk factors associated with readmission including pre‐operative conditions, laboratory results, operative variables, and postoperative complications. For readmission risk score assessment, a weighted logistic regression model was built and validated using ACS NSQIP 2011–2014 and 2015 data, respectively. Results: A total of 4797 patients were included with 963 (20%) patients readmitted within 30 days. Potentially modifiable risk factors included deep vein thrombosis, pulmonary embolism, renal insufficiency, wound infection, urinary tract infection, sepsis/septic shock, and pre‐existing congestive heart failure. Ten percent of patients with a risk score between 0 and 9 were readmitted, 18.5% with a score between 10 and 19, 52.2% with a score between 20 and 29, and 59.6% in patients with a risk score >29. Conclusions: Multiple potentially preventable risk factors are associated with 30‐day readmission following colectomy or proctectomy in UC patients. Higher risk scores are associated with increased risk of unplanned readmission.