INCIDENCE AND RISK FACTORS FOR READMISSION AFTER GRAM POSITIVE PNEUMONIA: A NATIONWIDE ANALYSIS.

Background: Pneumonia is a major health concern despite advances in preventive measures including vaccinations. In the United States, Pneumonia is one of the most common cause of hospital admissions other than child birth. One million adults seek care in a hospital due to pneumonia every year with nearly 5% succumb to Pneumonia(1). We sought to determine the incidence and predictors for readmission after gram positive pneumonia.

Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database which includes 14.9 Million discharges across 22 states to identify admissions with a principal diagnosis of Gram Positive Pneumonia using ICD-9 codes 482.3, 482.31, 482.32, and 482.39 (pneumonia due to streptococcus) and 482.40, 482.41, 482.42, and 482.49 (pneumonia due to staphylococcus). Applicable admissions were all adults (age >= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. Readmission’s that were either all-cause or related to pneumonia within 30-days of an index admission were analyzed with p-values < 0.05 considered statistically significant. Predictors for readmission were determined using a multi variable logistic regression model.

Results: Our study analyzed a total of 8,130 patients admitted for Gram Positive Pneumonia. There were 1,631 (overall rate of 20.06%) readmissions within 30-days of an index admission with Pneumonia. Predictors for readmission include those were discharged Against Medical Advice (Odds ratio (OR): 3.14, 95% Confidence interval CI 1.95-5.05), discharged to an Other Facility (OR: 1.54, CI: 1.33-1.78), discharge with Home Health Care (OR: 162, CI 1.39-1.88), admitted on a weekend (OR: 1.21 CI: 1.01-1.37), had an hospitalization with a length of stay between 7 and 14 days (OR:1.27, CI:1.12- 1.44) or greater than 14 days (OR: 1.31, CI: 1.11-1.53), and those who had the co-morbidity Chronic kidney disease present (OR:1.25, CI:1.09-1.42).

Conclusions: Pneumonia continues to be one of the leading causes of mortality and morbidity in the US(2). By studying predictors for readmission due to Gram Positive Pneumonia, targeted solutions can be delivered to who are at risk for readmissions preventing future morbidity and mortality.