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Readmissions for Malignant Pleural Effusions
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A4218 - Readmissions for Malignant Pleural Effusions
Author Block: T. S. Yang1, D. W. Hsia2, D. W. Chang3; 1Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States, 2Respiratory and Critical Care Physiology and Medicine, Harbor UCLA Med Center, Torrance, CA, United States, 3Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States.
Introduction: Readmission following hospitalizations for malignant pleural effusion (MPE) represent potential gaps in the management of MPE in both inpatient and outpatient settings. Identifying factors associated with readmissions may provide insights to improve the care of patients with MPE. Therefore, the goals of this study were to 1) determine the rate of readmissions following hospitalization for MPE, 2) determine the main causes of readmissions, and 3) identify patient and hospital-level factors associated with readmissions.
Methods: This was a retrospective cohort study of adults hospitalized for MPE during 2009 to 2011 using a state-wide administrative database from California. Hospitalizations for MPE were identified based on compatible ICD-9 CM codes as the primary diagnosis. The primary outcome was all-cause 30-day readmission rate following hospitalization for MPE. Hierarchical mixed effects logistic regression models were used to examine the association between patient and hospital-level factors and 30-day readmissions and to assess variation in readmission rates across hospitals.
Results: The all-cause 30-day readmission rate for MPEs was 38.3%. The 7, 14, 60, and 90 day readmission rates were 16.1%, 25.9%, 52.5%, and 63.8% respectively. The most common primary diagnoses for 30-day readmission were malignant pleural effusion (49.3%) and other clinical issues related to malignancy (28.6%). Patient and hospital level factors associated with 30-day readmissions were male gender, greater number of medical comorbidities, and having a do not resuscitate order. There was minimal variability in 30-day readmission rate across hospitals; hospitals in the 90th percentile were only 1.1 times more likely to have a 30-day readmission for MPE than those in the lowest 10th percentile (40.9% vs. 37%).
Conclusions: In California, greater than one-third of patients hospitalized for MPE are readmitted within 30 days and 30-day readmission rates were generally similar across all California hospitals. These findings suggest that rehospitalizations for progressive, terminal conditions such as MPE are unlikely to be mutable if aggressive care is pursued. Frequent hospitalization should therefore prompt consideration of care paradigms that deemphasize aggressive medical interventions in acute care hospitals, and focus on comfort and dignity at the end of life.
Author Block: T. S. Yang1, D. W. Hsia2, D. W. Chang3; 1Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States, 2Respiratory and Critical Care Physiology and Medicine, Harbor UCLA Med Center, Torrance, CA, United States, 3Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States.
Introduction: Readmission following hospitalizations for malignant pleural effusion (MPE) represent potential gaps in the management of MPE in both inpatient and outpatient settings. Identifying factors associated with readmissions may provide insights to improve the care of patients with MPE. Therefore, the goals of this study were to 1) determine the rate of readmissions following hospitalization for MPE, 2) determine the main causes of readmissions, and 3) identify patient and hospital-level factors associated with readmissions.
Methods: This was a retrospective cohort study of adults hospitalized for MPE during 2009 to 2011 using a state-wide administrative database from California. Hospitalizations for MPE were identified based on compatible ICD-9 CM codes as the primary diagnosis. The primary outcome was all-cause 30-day readmission rate following hospitalization for MPE. Hierarchical mixed effects logistic regression models were used to examine the association between patient and hospital-level factors and 30-day readmissions and to assess variation in readmission rates across hospitals.
Results: The all-cause 30-day readmission rate for MPEs was 38.3%. The 7, 14, 60, and 90 day readmission rates were 16.1%, 25.9%, 52.5%, and 63.8% respectively. The most common primary diagnoses for 30-day readmission were malignant pleural effusion (49.3%) and other clinical issues related to malignancy (28.6%). Patient and hospital level factors associated with 30-day readmissions were male gender, greater number of medical comorbidities, and having a do not resuscitate order. There was minimal variability in 30-day readmission rate across hospitals; hospitals in the 90th percentile were only 1.1 times more likely to have a 30-day readmission for MPE than those in the lowest 10th percentile (40.9% vs. 37%).
Conclusions: In California, greater than one-third of patients hospitalized for MPE are readmitted within 30 days and 30-day readmission rates were generally similar across all California hospitals. These findings suggest that rehospitalizations for progressive, terminal conditions such as MPE are unlikely to be mutable if aggressive care is pursued. Frequent hospitalization should therefore prompt consideration of care paradigms that deemphasize aggressive medical interventions in acute care hospitals, and focus on comfort and dignity at the end of life.
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