Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.200
Peer-review started: February 20, 2018
First decision: March 9, 2018
Revised: March 12, 2018
Accepted: April 2, 2018
Article in press: April 2, 2018
Published online: September 16, 2018
Gastroparesis is a chronic disorder that can lead to debilitating symptoms resulting in recurrent hospitalizations. These hospital admissions can be costly, especially if the patient is admitted repeatedly to different hospitals. Hospital readmissions can be underestimated if non-index readmissions (i.e., readmissions to a different hospital) are not captured during follow up.
Knowledge of the predictors of hospital readmissions can help design interventions that focus on high risk factors. Estimating the rate of care fragmentation provides further insight into the burden of gastroparesis on patients and the healthcare system. It also highlights the need to refine the methods to calculate hospital readmission.
The study aims to evaluate the rate of hospital readmissions in gastroparesis, and to estimate the proportion of readmissions to index and non-index hospitals (care fragmentation). We also sought to study factors related to readmission and care fragmentation, and their effect on future outcomes such as length of stay, costs, mortality, and readmissions.
We used the national readmission database to identify all adult admissions with primary diagnosis of gastroparesis. We calculated the rate of 30 and 90-d statewide hospital readmissions and care fragmentation. We analyzed factors related to hospital readmission and care fragmentation using multivariable models.
We found a high rate of hospital readmission in gastroparesis (26.8% at 30 d and 45.6% at 90 d). Around one fourth of readmissions occur at a different hospital, and 20% occur exclusively at a different hospital. This means that 20% of all 30-d readmissions will not get captured if local hospital databases are used to track patients. Readmission to a different hospital within 30-d was associated with higher hospitalization costs and length of stay. We identified several sociodemographic and clinical factors that are associated with hospital readmission and care fragmentation. Gastric surgery is associated with decreased risk of readmission, while enteral tube insertions (gastrostomy or jejunostomy) did not affect readmissions.
This is the first population based study to highlight the high rate of hospital readmission and care fragmentation in gastroparesis. It is also the first to report several sociodemographic and clinical factors related to these outcomes, which can be used to identify high-risk patients.
In addition to reducing hospital readmissions, hospitals should also attempt to decrease care fragmentation because it is associated with increased costs of care. Hospital readmissions are a major cause of morbidity in gastroparesis. Trials involving different interventions for gastroparesis should also evaluate the effect of these interventions on reducing hospital readmissions.