P0309 - Patients Hospitalized for Eosinophilic Esophagitis Are Likely to Be Readmitted Within 180 Days but for Non-EoE Reasons

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Ransome Eke, MD, PhD

University of Alabama
Tuscaloosa, AL, United States

Ransome Eke, MD, PhD¹, Evan S. Dellon, MD, MPH, FACG²
¹University of Alabama, Tuscaloosa, AL; ²University of North Carolina School of Medicine, Chapel Hill, NC

Introduction: Recent data have indicated that the rate of hospital admissions for eosinophilic esophagitis (EoE) has markedly increased in the US within the past seven years. However, readmissions of patients after hospitalization for EoE have not been well studied. We aimed to examine the rate of readmission and reasons for readmission after hospital discharge among patients with EoE-associated diagnoses in U.S. hospitals.

Methods: We identified the index EoE hospitalization recorded in the Healthcare Cost and Utilization Project National Readmission Database, from 2012-2018. Index EoE hospitalization was defined by having a primary or secondary ICD9/10 diagnostic code for EoE during admission. We extracted patient demographic information and hospital characteristics. We measured readmission within 180 days after discharge from the EoE-related hospitalization and determined the proportion of patients who were readmitted and the most common readmission diagnoses. We compared characteristics of EoE patients who experienced versus did not experience readmission within 180 days using the Pearson chi-square and Wilcoxon rank-sum tests.

Results: For the 15,535 index hospitalizations for EoE that met our definition (of which 3,123 (20.1%) had an EoE code in the primary position), 58.6% of patients were adults, 74.7% of the patients resided in small metropolitan/rural areas, 65.7% of the index hospitalizations occurred in large bed size hospitals, and most of the admissions were non-elective (81.6%). Within 180 days of discharge, 3,636 (23.4%) of EoE patients were readmitted, and of these, 861 (23.7%) had EoE related diagnoses. However, only 181 (5.0%) of the readmissions were primarily due to EoE. The 5 most common non-EoE reasons for readmission were Asthma (5.5%), septicemia (3.2%), non-cardiac chest pain (2.5%), volume depletion/dehydration (2.0%), diabetes (1.7%). Readmitted patients had higher severity of illness subclass, especially Medicaid and Medicare insurance, and had percentile median household income of less than 50 or below percentile.

Discussion: In this national sample of hospitalized EoE patients, nearly a quarter were readmitted within 180 days after discharge. However, only 5% of the readmissions were primarily due to EoE, and instead were related to asthma, sepsis, and others. Efforts are needed to recognize and mitigate potentially preventable readmissions in EoE patients for non-EoE reasons.

Variable	Overall EoE at index admission (n=15535	180-Day Readmission (n=3636; 23.4%)	No 180-Day Readmission (n=11899; 76.6%)	P Value
Age, y	31.5 ± 0.75	31.8 ± 1.2	31.5 ± 0.7	0.004
Age group
0 - 18 y	41.4%	44.9%	40.3%	0.039
≥19 y	58.6%	55.1%	59.7%
Female	39.3%	41.7%	38.6%	0.154
EoE primary at index admission	20.1%	5.4%	24.9%	< 0.001
Length of index hospitalization, d	3 ± 0	5 ± 1	4 ± 1	< 0.001
Mean hospital charge, US $	34015 ± 1028	40978 ± 2370	31858 ± 942	< 0.001
Severity of Illness Subclass
Minor	25.1%	14.6%	28.4%	< 0.001
Moderate	50.0%	49.4%	50.2%
Severe	24.9%	36.0%	21.4%
Percentile median household income by Zip
0–25th	22.4%	23.6%	22.0%	0.007
26–50th	25.9%	30.1%	24.6%
51–75th	25.6%	25.3%	25.6%
76–100th	26.1%	20.9%	27.7%
Patient location
Large urban metropolitan	25.3%	23.8%	25.8%	0.229
Small metropolitan/rural	74.7%	76.2%	74.2%
Insurance
Medicare	15.3%	20.2%	13.9%	< 0.001
Medicaid	24.8%	30.7%	23.0%
Other/self-pay/uninsured	7.9%	5.5%	8.7%
Private insurance	52.0%	43.6%	54.5%
Hospital bed size
Large	65.7%	70.2%	64.3%	< 0.001
Medium	22.0%	19.3%	22.8%
Small	12.3%	10.5%	12.9%
Hospital location
Large urban metropolitan	61.7%	60.5%	62.0%	< 0.001
Small metropolitan/rural	38.3%	39.5%	38.0%
Hospital teaching status
Nonteaching hospital	22..4%	18.5%	23.5%	< 0.001
Teaching hospital	77.6%	81.5%	76.4%
Admission type
Nonelective	81.6%	81.8%	81.5%	< 0.001
Elective	18.4%	18.1%	18.5%
Admission day
Weekend	21.6%	22.2%	21.4%	< 0.001
Weekday	78.4%	77.8%	78.6%
Admission quarter
January - March	21.9%	13.7%	24.4%	< 0.001
April – June	23.3%	24.3%	22.0%
July – September	26.3%	31.4%	24.7%
October – December	28.5%	30.6%	27.9%

Table: Table 1: Patient and Hospital characteristics of EoE Readmissions Within 180 Days of Hospital Discharge

Disclosures:

Ransome Eke indicated no relevant financial relationships.

Evan Dellon indicated no relevant financial relationships.

Ransome Eke, MD, PhD¹, Evan S. Dellon, MD, MPH, FACG². P0309 - Patients Hospitalized for Eosinophilic Esophagitis Are Likely to Be Readmitted Within 180 Days but for Non-EoE Reasons, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.