P776 Hospital re-admission in patients with inflammatory bowel disease: what are the risk factors?
R. Fromson, E. Johnson, E. Routledge, S. Jameie-Oskooei, W. Blad, R. Patel, V. Wong
Whittington Hospital, Gastroenterology, London, UK
Background
Early re-admission after hospitalisation for an inflammatory bowel disease (IBD) flare is a negative quality indicator and causes unnecessary healthcare expense. Scoring systems to predict IBD readmissions have been shown to be ineffective. We aimed to describe the IBD re-admission rate at our hospital and investigate the risk factors.
Methods
Retrospective study of patients admitted to a London-based district general hospital under the gastroenterology team with a flare of inflammatory bowel disease between 2015 and 2018. Characteristic including but not limited to demographics, disease type, length of stay (LOS) during index admission, biochemistry and biologic use were recorded. Hospital software (Sunquest Integrated Clinical Environment, Medway) was used to identify patients re-admitted at 30 and 90 days after discharge. Multivariate logistic regression was performed.
Results
One hundred and thirty-eight patients were admitted with an IBD flare during the study period (74 (53.6%) Crohn’s disease (CD), 56 (40.6%) ulcerative colitis (UC), 8 (5.8%) IBD-U). Median age 33.5 (IQR 26–52), 71 (51.4%) female. Median LOS was 4.5 days (IQR 1.8–8). 36 (26%) patients were taking a biologic. Re-admissions occurred within 30 days in 19 patients (13.7%) and within 90 days in 30 patients (21.7%). Multivariate logistic regression showed that a raised CRP on discharge was associated with re-admission. For every increased unit of CRP by one there was an increased risk of readmission by 1.1 times (
| 30-day Re-admission ( | No Re-admission ( | * | |
| CRP on discharge (median, IQR) | 23 (5.5–59.3) | 9 (2–25) | *0.005 |
| Albumin on discharge (median, IQR) | 37 (31.5–41.5) | 36 (31.3–41) | 0.45 |
| Biologic use, n (%) | 6 (28.6) | 30 (25.6) | 0.78 |
| 90-day Re-admission ( | No Re-admission ( | * | |
| CRP on discharge (median, IQR) | 15 (5–50) | 9 (2–24.3) | *0.03 |
| Albumin on discharge (median, IQR) | 37 (31–41) | 36 (31.5–41) | 0.45 |
| Biologic use, | 10 (31.3) | 26 (24.5) | 0.45 |
Conclusion
The 30 days and 90 days re-admission rate for our IBD population is just over 10% and 20%, respectively. CRP at discharge is significantly associated with both 30 and 90 days re-admission. After adjusting for confounders; CRP, age older than 40 and male gender were associated with re-admission to hospital. We advise caution in discharging IBD patients with raised inflammatory markers. Close follow-up within a few days of discharge would be appropriate in this high-risk sub-group.