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P551 Hospital readmissions in patients with inflammatory bowel disease: A UK single centre experience

L. Chan*, E. Wood, L. Fang, J. Limdi

Pennine Acute Hospitals NHS Trust, Gastroenterology, Greater Manchester, United Kingdom

Background

The prevalence of inflammatory bowel disease (IBD) is increasing worldwide. Meanwhile, evolving definitions of disease control and outcome measures coupled with the rising direct and indirect cost of IBD therapy underpin the need to examine health care utilization and processes mitigating the economic impact whilst delivering value improvement in IBD care. Hospital inpatient admissions are increasing in the UK with an estimated annual cost of all cause 28-days readmissions of £2.2 billion each year to the National Health Service [1]. IBD accounts for approximately 108,000 hospitalizations in the UK each year [2]. We aimed to assess the readmission rate and associated predictive risk factors in our IBD cohort.

Methods

Patient readmissions within 28-days of an index admission, resulting from an exacerbation of IBD, to our inpatient gastroenterology service were identified using local hospital databases from April 2011 to October 2013. We retrospectively reviewed and carried out a descriptive analysis of patient demographics, baseline IBD and index admission factors, and reasons for readmission.

Results

We identified 157 patients, 57.6% female and 42.4% male, admitted at a mean age of 44 years with Crohn's disease (47.1%, n=113), Ulcerative colitis (46.3%) or indeterminate colitis (6.6%). The readmission rate within 28-days of index admission was 21% (n=33). These occurred following a mean average of 16 days, due to dehydration/anaemia (27.3%), surgery or surgical complications (12.2%), pain control (6.1%), sepsis (6.1%), obstruction (6.1%), venous thromboembolism (3.0%) or other/unknown (39.2%). Readmissions occurred more commonly in younger patients (t-test, p<0.05), who had less severe endoscopic and microscopic baseline IBD disease (X2=5.194, p<0.05, n=112), shorter length of stay during index admission (t-test, p<0.02, n=99) and who were discharged with less opioid analgesia (X2=9.669, p<0.005, n=114).

Conclusion

CONCLUSION IBD readmission rates are higher than general readmission rates for myriad reasons that remain complex and challenging [2]. Identifying and addressing avoidable risk factors has the potential to empower and deliver optimal and high standard care and better outcomes with the ability to improve and reassess cost-efficacy in the context of a full cycle of care.

References:

[1] NHS CEP, (2011), The impact of non-payment for acute readmissions, NHS Confederation, London

[2] HES Analysis, (2013), Hospital Episode Statistics: Admitted patient care 2012-13, HSCIC, London