Abstracts

Rationale: Thirty-day readmission rates have increasingly gained importance as a quality metric for hospitals. Unplanned readmissions are associated with increased health care expenditure. However, there is paucity of data on 30-day readmission rates in patients with epilepsy, particularly those admitted for status epilepticus (SE). SE is often associated with prolonged hospitalization, multiple comorbidities, and cognitive deficits, all of which make these patients extremely vulnerable to repeated hospitalizations. The objective of this study was to determine the incidence, causes, predictors reasons, and costs of 30-day readmissions in patients admitted with SE from a large representative United States (US) cohort. Methods: Adult (age =18 years) patients hospitalized with the primary diagnosis of SE (International Classification of Diseases-Ninth Revision-CM codes 345.2 or 345.3) between January 2013 and September 2015 who survived the index hospitalization were identified using the Nationwide Readmissions Database. Incidence, causes, and costs of 30-day readmissions were analyzed. Multivariable logistic regression model was used to identify independent predictors of 30-day readmissions. Results: Of 42,232 patients with index SE, 6,372 (15.0%) were readmitted within 30 days. Intracranial hemorrhage (odds ratio [OR], 1.56; 95% CI, 1.12–2.18), psychosis (OR, 1.25, 95% CI, 1.05- 1.50), diabetes mellitus (OR, 1.12, 95% CI, 1.00- 1.25), chronic kidney disease (OR, 1.50, 95% CI, 1.31- 1.72), chronic liver disease (OR, 1.51; 95% CI, 1.24–1.84), >3 Elixhauser comorbidities (OR, 1.18; 95% CI, 1.06–1.31), length of stay >4 days during index hospitalization (OR, 1.41; 95% confidence interval [CI], 1.28–1.56) and discharge to skilled nursing facility (OR, 1.14; 95% CI, 1.01–1.28) were independent predictors of 30-day readmission. The most common reason for readmission was convulsion/epilepsy (45.1%). Other non-epilepsy related readmissions were due to medical conditions; sepsis (6.6%), respiratory failure (2.4%), urinary tract infection (2.2%) or other neurologic causes (2.2%).  Median length of stay and costs of readmission were 4 days (interquartile range, 2–7 days) and $7,882 (interquartile range, $4,649–15,012), respectively. Conclusions: Thirty-day readmissions after status epilepticus are frequent. Majority of these are related to recurrent seizures. Readmitted patients were more likely to have multiple comorbidities, longer length of stay, and discharge to skilled nursing home facility. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs. Funding: None