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Abstract Details

Causes and Predictors of 30-Day Readmission in Elderly Patients with Delirium
General Neurology
S1 - Neuroepidemiology (1:33 PM-1:44 PM)
004

Delirium, a common cause for acute hospitalization among elderly patients is associated with significant morbidity, mortality, and economic cost especially with re-hospitalizations.  Studying risk factors associated with unplanned readmission may help lower readmission rates.

To study nationwide statistics of 30-day readmissions (30-DR) among elderly patients following hospitalization for delirium.

This was a retrospective observational study of elderly patients (age ≥65 years) hospitalized with a primary discharge diagnosis of delirium using the 2013 Nationwide Readmission Database (NRD).  Cases were identified by ICD9-CM codes linked to drug-induced delirium, alcohol-withdrawal delirium, encephalopathy-NOS, subacute delirium, and delirium with dementia.  The causes of 30-DR were identified by primary readmission discharge diagnoses. Multivariate logistic regression analyses were performed adjusting for stratified cluster design of NRD to identify the patient/system-specific factors associated with 30-DR.

Overall 30-DR rate was 17% (7140 of 42,655 weighted index admissions) and the median interval to readmission was 10 days.  The common causes of readmission were infection (18%), systemic diseases (11.4 %; acute kidney injury, congestive heart failure, respiratory failure), CNS disorders (5.9%), delirium-associated cognitive disorders (4.8%), alcohol-related (2.5%), and aspiration pneumonia (2.2%).  Compared to initial (index) hospitalization, readmission had higher mean length-of-stay (LOS; 6.9 vs. 6.1 days, p<0.0001) and hospitalization cost ($12594 vs. $10533, p<0.0001).  Independent predictors of readmission included discharge against medical advice (OR 1.9, p< 0.0034), >6 days LOS (OR 1.3, p<0.0001), chronic renal failure (OR 1.4, p<0.0001), CHF (OR 1.3, p<0.0001), chronic lung disease (OR 1.2, p<0.0004), and chronic liver disease (OR 1.2, p<0.03).  Having private insurance was associated with a lower risk of readmission (OR 0.78, p<0.02).

The 30-DR rate among elderly patients hospitalized with delirium was 17%.  The main predictors of readmission were sepsis and systemic diseases.  Implementation of care pathways to optimize management of these conditions may help reduce avoidable readmissions and associated cost.

Authors/Disclosures
Hsien Lee Lau, MD
PRESENTER
No disclosure on file
Smit D. Patel, MD, MPH Dr. Patel has nothing to disclose.
Neeta Garg, MD (Harbor UCLA Medical Center) Dr. Garg has nothing to disclose.