187. The Likelihood of Hospital Readmission among Patients with Hospital-Onset Central Line-Associated Bloodstream Infection (HO-CLABSI)
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Hospital readmission increases healthcare burden and costs.  This study sought to determine whether HO-CLABSI increases the likelihood of readmission to an acute care hospital.

Methods: In this retrospective matched cohort study, we compared the rate of readmission to an acute care hospital among Medicare recipients with and without HO-CLABSI during an index hospitalization.  HO-CLABSI and readmission status were determined by linking data from the National Healthcare Safety Network surveillance system to the Centers for Medicare & Medicaid Services’ Medical Provider and Analysis Review in eight states for which data were available.  In addition to frequency matching on ICD-9-CM procedure code category and intensive care unit status, multivariate models included covariates such as race, sex, length of index hospitalization stay (LOS), central line procedure code, GAGNE co-morbidity score, and individual chronic conditions.  We used Cox Proportional Hazard analysis to assess rate of readmission, defined as the first hospitalization within 30 days following index discharge.

Results: Of the 8,115 patients in the cohort, 2,290 were readmitted (28.2%).  The rate of first readmission was 6.8 events/ person-year (PY) for HO-CLABSI patients and 4.1 events/ PY for non-CLABSI patients (p <.001).  The final model revealed a significant association between HO-CLABSI status and readmission, with effect modifiers LOS and rheumatoid arthritis (see Table).

Table.  Multivariable Analysis: Comparison of Readmission Rates Among Patients with and without HO-CLABSI by Length of Stay and Presence of Rheumatoid Arthritis (RA)

 

Patients without RA

Patients with RA

IRR†

95% CI

IRR

95% CI

Index Length of Stay

< 6 days

5.62

(2.95, 10.72)

7.24

(3.82,13.69)

7-12 days

1.51

(0.99, 2.32)

1.95

(1.25, 3.04)

13-22 days

1.08

(0.84, 1.40)

1.40

(1.03, 1.88)

> 22 days

0.99

(0.83, 1.18)

1.27

(0.99, 1.63)

†Incidence Rate Ratio

Conclusion: Our analysis found a statistically significant association between HO-CLABSI status and readmission, suggesting that HO-CLABSI may have adverse health impact that extends beyond hospital discharge. Preventing HO-CLABSI may reduce the risk of hospital re-admission.

Carolyn Chi, MPH1, David Kleinbaum, PhD2, Ronda Sinkowitz-Cochran, MPH3, John A. Jernigan, MD, MS3 and James Baggs, PhD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

C. Chi, None

D. Kleinbaum, None

R. Sinkowitz-Cochran, None

J. A. Jernigan, None

J. Baggs, None

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