Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2021; 13(2): 141-152
Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.141
Hospital outcomes and early readmission for the most common gastrointestinal and liver diseases in the United States: Implications for healthcare delivery
Somashekar G Krishna, Brandon K Chu, Alecia M Blaszczak, Gokulakrishnan Balasubramanian, Hisham Hussan, Peter P Stanich, Khalid Mumtaz, Alice Hinton, Darwin L Conwell
Somashekar G Krishna, Alecia M Blaszczak, Gokulakrishnan Balasubramanian, Hisham Hussan, Peter P Stanich, Khalid Mumtaz, Darwin L Conwell, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Brandon K Chu, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Alice Hinton, Division of Biostatistics, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Krishna SG designed the study, interpreted the data, contributed to the figures and tables, revised the manuscript and supervised the study; Chu BK designed the study, interpreted the data, contributed to the figures and tables and wrote the manuscript; Blaszczak AM designed the study and wrote the manuscript; Conwell DL designed the study, interpreted the data and revised the manuscript. Hinton A performed the statistical analyses, designed the tables and revised the manuscript; Balasubramanian G, Hussan H, Stanich PP, and Mumtaz K interpreted the data and revised the manuscript.
Institutional review board statement: Data for this study was obtained from querying the Nationwide Readmission Database (2013) and the Nationwide Inpatient Sample (2012). Institutional Review Board approval was not necessary for a population-based public data set based on The Ohio State University Data and Specimen Policy and Human Subjects Research Policy.
Informed consent statement: Informed consent approval was not necessary for a population-based public data set based on The Ohio State University Data and Specimen Policy and Human Subjects Research Policy.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Data sharing statement: Data for this study was obtained from querying the Nationwide Readmission Database (2013) and the Nationwide Inpatient Sample (2012). No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Somashekar G Krishna, AGAF, FACG, FASGE, MD, Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Received: November 12, 2020
Peer-review started: November 12, 2020
First decision: December 12, 2020
Revised: December 24, 2020
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: February 27, 2021
Processing time: 83 Days and 14 Hours
ARTICLE HIGHLIGHTS
Research background

Gastrointestinal (GI) related diseases account for over $100 billion in healthcare expenditures in the United States.

Research motivation

Currently, few population-based studies are evaluating key hospital metrics such as thirty-day readmission rates, mortality and predictors of thirty-day readmissions for the most common GI diseases as a whole. Obtaining this information can provide further insights for clinicians and key stakeholders in recognizing the impact of these diseases and identifying opportunities for improved healthcare delivery.

Research objectives

We aimed to find the most common GI-related illnesses and calculate the total index admissions, thirty-day readmission rates, mean length of stay, mean hospitalization costs, and the mortality rates for each of these diseases. We also sought to assess predictors of thirty-day readmissions for these conditions.

Research methods

The Nationwide Inpatient Sample (2012) identified the 13 most common GI and Liver disease hospitalizations, which included GI hemorrhage, cholelithiasis with cholecystitis, acute pancreatitis, and Clostridium difficile (C. difficile) infection. The 2013 Nationwide Readmission Database was then queried with each disease to obtain hospital outcomes and readmission data. Multivariable logistic regression analyses for each disease group identified predictors for thirty-day readmission.

Research results

The thirteen GI diseases accounted for 2.4 million index hospitalizations and $25 billion in healthcare-associated costs. Chronic conditions such as those involving the liver, functional/motility disorders and inflammatory bowel disease were associated with high readmission rates, mortality rates and hospitalization costs. However, potentially preventable and non-chronic GI ailments such as GI hemorrhage, acute pancreatitis and C. difficile infection were also linked with considerable readmission rates, mortality rates and hospitalization costs. Patient variables such as type of insurance, presence of ≥ 3 Elixhauser comorbidities, and length of stay > 3 d were predictors of thirty-day readmission for all the thirteen GI diseases.

Research conclusions

GI-related diseases contribute to substantial inpatient morbidity, mortality and healthcare resource utilization. Our study highlighted the sizeable portion of readmissions, mortality rates and hospitalization costs attributed to potentially preventable and non-chronic GI diseases such as C. difficile infection, gastrointestinal bleeding, and acute pancreatitis.

Research perspectives

Our study identifies a need for improved healthcare quality and a stronger emphasis on preventative medicine to decrease the overall GI burden, especially with preventable and non-chronic GI diseases.