Internal Medicine Resident White River Health System Batesville, AR
Neal Mehta, MD, MPH, MBA, MS, Gilbert Kamoga, MD; White River Health System, Batesville, AR
Introduction: The incidence of diverticulitis has continued to rise and represents a significant portion of gastrointestinal related hospitalizations . It is postulated that urban and rural patients may have different outcomes. We sought out to determine the incidence and risk factors for 30-day all-cause readmission after an admission with acute diverticulitis originating from a rural or urban location. Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2010-2014 Nationwide Readmission Database to identify admissions with a principal diagnosis of Diverticulitis of the Colon without mention of hemorrhage (ICD-9 562.11). The 2006 and 2013 NCHS Urban-Rural Classification System was used to classify if originating from a urban or rural location. Applicable admissions were all adults (age >= 18) from January 1 to November 30 of each respective year. Patients who died during the index admission or with missing covariates being excluded. Unplanned readmissions that were either all-cause or related to diverticulitis within 30-days of an index admission were included. Predictors for readmission were determined using a multivariable logistic regression model. Results: A total of 413,445 individuals met criteria for inclusion with 38,154 all-cause readmissions (9.23%) within 30-days of which 12,484 (32.72%) were readmitted with a principle diagnosis of diverticulitis. The overall readmission rate for individuals originating from a rural (8.44%) or urban (9.36%) was statistically significant (p < 0.01). From a rural location, the predictors for readmission were discharge to Short Term Hospital (OR 2.19, p < 0.01), Other Facility (OR 1.47, p < 0.01), with Home Health Care (OR 1.40, p < 0.01) or AMA (OR 2.78, p < 0.01), had Medicaid (OR 1.33, p < 0.01), longer LOS, and had CKD (OR 1.42, p < 0.01) present. This was similar to those originating from an urban location with the predictors being a weekend admission (OR 1.06, p < 0.01), discharged to Short Term Hospital (OR 1.53, p < 0.01), Other Facility (OR 1.54, p < 0.01), with Home Health Care (OR 1.40, p < 0.01) or AMA (OR 2.20, p < 0.01), had Medicaid (OR 1.14, p < 0.01), longer LOS, and had CKD (OR 1.30, p < 0.01) present. Discussion: While the readmission rate for rural and urban patients is different, the risk factors are relatively similar. Additional research is needed to develop targeted interventions for individuals at higher risk for readmission. References:  Strate, et al. Gastroenterology. 2019 Apr;156(5):1282-1298.e1
Disclosures: Neal Mehta indicated no relevant financial relationships. Gilbert Kamoga indicated no relevant financial relationships.