Association of 30 Day Readmission between Psychosocial, Behavioral and Epidemiological Factors in Adult SCD Patients

Background: Sickle-cell disease (SCD) has been identified as a major public health problem by the World Health Organization (WHO) and is one of the most common hematological genetic diseases. In United States, there are approximately 100,000 admissions per year attributed to SCD. Our objective is to provide nationally representative rates for unplanned 30-day readmissions in SCD patients as well as identify reasons for, characteristics and predictors of these readmissions.

Methods: We performed retrospective analysis using the 2013 Nationwide Readmissions Database (NRD) of the Healthcare Cost and Utilization Project (HCUP) from AHRQ. We used chi-square tests, t tests, and Wilcoxon rank-sum tests for descriptive analyses and survey logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations with readmissions adjusting for confounders.

Results : Of the 46,842 hospitalizations with SCD as the primary diagnosis for the index admission, 11,787(25.2%) had at least one 30-day unplanned readmission and 30% of these readmissions were within the first week after discharge. Among 11,787 readmissions, 83% of the readmissions were attributed to SCD, including 81.5% due to acute painful crisis. Patients who got readmitted were likely to be younger, with more comorbidity burden including chronic kidney disease, asthma, drug abuse and hypertension. Predictors of readmissions included: age 18-29 years (aOR 1.5, 95% CI 1.3 - 1.6; P<0.01), chronic kidney disease (aOR 1.3, 95% CI 1.1 - 1.6, P <0.01), depression (aOR 1.2, 95% CI 1.1 - 1.4, P<0.01), drug abuse (aOR 1.2, 95% CI 1.1 - 1.4, P 0.04), and discharge against medical advice (AMA) (aOR 1.8, 95% CI 1.5-2.1, P<0.01. AMA discharges and depression were responsible, respectively, for 76% and 23% increases in the odds of 30-day readmission.

Conclusion: About a quarter of patients admitted with SCD get re-admitted within a month of discharge. This calls for identification of modifiable risk factors and timely intervention with safe hospital discharge which is critically important for patient care and national health expenditure.