Background: In the United States, the relative incidence of diverticulitis has continued to rise and represents a significant portion of gastrointestinal related hospitalizations [1]. Management and treatment can include both medical and surgical options. Of recent, considerable attention has been given to try to decrease healthcare utilization [2]. We sought out to determine the annual incidence and risk factors for 30-day all-cause readmission for adults (age >= 18) after an admission with acute diverticulitis over a 5-year period, 2010-2014.
Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2010-2014 Nationwide Readmission Database which includes 70.5 Million discharges across 22 states to identify admissions with a principal diagnosis of Diverticulitis of the Colon without mention of hemorrhage or ICD-9 code 562.11. Applicable admissions were all adults (age >= 18) from January 1 to November 30 of each respective year. Patients who died during the index admission and those with missing covariates were excluded. Unplanned readmissions that were either all-cause or related to diverticulitis within 30-days of an index admission were analyzed with p-values < 0.05 considered statistically significant. Predictors for readmission were determined using a multivariable logistic regression model.
Results: A total of 413,597 individuals met criteria for inclusion in this study with 38,177 or an all-cause readmission rate of 9.23%. Of those readmissions, 12,487 (32.71%) were readmitted with a principle diagnosis of diverticulitis. The readmission rate was relatively stable between 2010 and 2014 (9.10% to 9.35%). Those readmitted had a mean LOS that was 6.30 days compared to 4.73 days for those that were not readmitted (p < 0.01). Predictors of readmission were admission on a weekend (OR 1.05, p < 0.01), admission to a Metropolitan Teaching hospital (OR 1.07, p < 0.01), discharge to Short Term Hospital (OR 1.87, p < 0.01) or Other Facility (OR 1.69, p < 0.01) or with Home Health Care (OR 1.49, p < 0.01) and AMA (OR 2.26, p < 0.01), had Medicaid insurance (OR 1.08, p < 0.01), longer LOS stay, and had either the comorbidity obesity (OR 1.16, p < 0.01) or CKD (OR 1.54, p < 0.01) present. Compared to the reference age group (65 to 75), all age groups including 18 to 35 (OR 1.17, p < 0.01), 35 to 65 (OR 1.15, p < 0.01), 75 to 85 (OR 1.21, p < 0.01) and 90+ (or 1.40, p < 0.01) were predictors for readmission.
Conclusions: Nearly 1 in 10 individuals with diverticulitis will be readmitted for all-cause within 30-days. The readmission rate has remained relatively steady throughout the study period. Predictors for readmission range from weekend admission, a non-routine discharge, presence of Medicaid, and certain comorbidities. Additional research is needed to develop targeted interventions for populations at higher risk for readmission to decrease future morbidity and mortality.