2079. Hospital readmissions related to Clostridium difficile infection
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall
Background: More 20-30% of Clostridium difficile infection (CDI) cases recur with each subsequent episode contributing to a higher risk of readmission. We utilized the 2013 Nationwide Readmissions Database from AHRQ with the specific aim of identifying patient characteristics that predisposed to an increased risk of CDI-associated readmission following an initial hospital discharge related to the diasease.

Methods: We used the ICD-9 code 00845 to identify the initial occurrence of all hospitalizations involving CDI for the month of January 2013; designated as CDI-associated index admissions. We queried the database for all CDI-associated readmissions that occurred after an index admission from January-December 2013. Index admissions were then grouped into two categories; those without a readmission and those with one or more subsequent readmissions. Study variables included diagnoses, costs, LOS and ICU stay.

Results: In January 2013, there were a total of 29,551 individual CDI-related hospitalizations. In index cohort, 9.4% patients died during hospitalization and 68% did not undergo a subsequent CDI-associated hospitalization for the remaining period of the study. The remaining 22.5% experienced at least one hospital readmission related to CDI. The readmission group of patients underwent a total of 10,158 CDI-associated readmissions from January-December 2013; 32.3% of these involved a principal diagnosis of CDI. The number of median (IQR) readmissions per patient was 2 (1) and the time to readmission was 29 (59) days. The cost associated with readmission related to CDI was $8,000 ($8,000) and the LOS was 5 days. The readmission patients were significantly more likely to have a principal diagnosis of CDI (38.6% vs 32.3%, p<0.001), be older (age ≥65 years; 65.3% vs 63.5%, p<0.001) and be insured by Medicare (74.2% vs 68.7%, p<0.001) compared to the non-readmission group. Independent risk factors for CDI-associated readmission were IBD (aOR 1.32; 95%CI 1.15-1.52) and coverage by Medicare (aOR 1.37, 95%CI 1.26-1.49).

Conclusion: Our results indicate a significant healthcare burden involving readmissions, manifested as a high rate of CDI-associated re-hospitalizations and substantial associated hospital stays and costs. Insurance coverage by Medicare and the presence of IBD were independently associated with a higher risk of CDI-associated readmission.

Abhishek Deshpande, MD, PhD, Medicine Institute, Cleveland Clinic, Cleveland, OH; Infectious Disease, Cleveland Clinic, Cleveland, OH, Chaitanya Pant, MD, Kansas University Medical Center, Kansas City, KS, Mojtaba Olyaee, MD, Gastroenterology, Kansas University Medical Center, Kansas City, KS and Curtis J. Donskey, MD, Infectious Diseases, Case Western Reserve University, Cleveland, OH

Disclosures:

A. Deshpande, 3M: Research Contractor , Research grant and Research support
Clorox: Grant Investigator , Research grant and Research support
STERIS: Grant Investigator , Research grant and Research support

C. Pant, None

M. Olyaee, None

C. J. Donskey, None

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