A0344 - Impact of Malnutrition on Readmission Rate in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Muhammad Haseeb, MD, MSc

Beth Israel Deaconess Medical Center
Boston, MA

Fnu Faheela, MBBS¹, Umar Hayat, MBBS², Maham Waqar, MBBS³, Muhammad Kamal, MD⁴, Muhammad Haseeb, MD, MSc⁵
¹Nishtar Medical University, Multan, Punjab, Pakistan; ²University of Kansas, Wichita, KS; ³King Edward Medical University, Lahore, Punjab, Pakistan; ⁴Essen Healthcare System, New York, NY; ⁵Beth Israel Deaconess Medical Center, Boston, MA

Introduction: Malnutrition is a common complication in patients with Inflammatory Bowel Disease (IBD) because of chronic inflammation in the gut. It negatively impacts patients’ quality of life. Our study aimed to evaluate the impact of malnutrition on the readmission rate in patients hospitalized with IBD in the US.

Methods: National Readmission Database (NRD) for 2019 was queried using ICD-10-CM Codes to identify a cohort of IBD admissions with and without Malnutrition. A weighted sample was used to get baseline characteristics and a 30-day readmission rate. Univariate and multivariate logistic regression analyses were used to analyze unadjusted and adjusted odds of readmission.

Results: Among 76480 patients admitted with IBD, 11564 (15.1%) also had a concurrent diagnosis of malnutrition. Patients with malnutrition had a higher Charlson Comorbidity Index. Our cohort was broadly admitted to large urban teaching hospitals. Compared to patients with malnutrition, there were larger proportions of patients with private insurance without Malnutrition (41.5% vs. 45.1%). The 30-day all-cause readmission rate was higher in malnourished IBD patients compared to non-malnourished (18.4 vs. 13.3, p-value < 0.01). The adjusted Odds of Readmission for IBD patients with malnutrition were 1.41 times higher (95% CI 1.30-1.52) than those without malnutrition. The top 5 diagnoses for readmission included complications due to IBD and sepsis. There was an increased proportion of readmissions with sepsis in patients with malnutrition compared to the baseline group (6.4% vs. 5.7%).

Discussion: Our study shows that malnutrition was associated with a significantly higher risk of 30-day readmission in patients admitted with IBD. In addition, these patients are at increased risk of readmission due to infection. Frequent hospitalizations in IBD patients put a substantial burden on the health care system. Therefore, careful attention is needed for early screening and prompt management of malnutrition in inpatient and outpatient settings to decrease the risk of hospitalization in this patient population.

Figure: IBD: Inflammatory Bowel Disease ; IBD+Malnutrition: Inflammatory Bowel Disease with Malnutrition

Variables	IBD without Malnutrition (64916)	IBD with Malnutrition (11564)	p-value
a) Baseline Patient and Hospital Characteristics
Age (SD)	46.7 (18.8)	47.0 (19.9)	0.35
Female (%)	35385 (54.5)	5611 (48.5)	< 0.01
Charlson Comorbidity Index (SD)	0.70 (1.4)	0.86 (1.6)	< 0.01
Hospital Type (%)
Urban	63920 (98.5)	11511 (99.5)	< 0.01
Teaching	48284 (74.4)	9520 (82.3)	< 0.01
Hospital Bed Size (Large)	34524 (53.2)	7213 (62.4)	< 0.01
Payer Information (%)			< 0.01
Medicare	18044 (28.9)	3605 (32.4)
Private Insurance	28110 (45.1)	4622 (41.5)
Disposition (%)			< 0.01
Home AMA Died	56907 (87.7) 1846 (2.9) 112 (0.2)	7982 (69.1) 160 (1.4) 163 (1.4)
30 Days Readmission Rate	8060 (13.3)	1953 (18.4)	< 0.01
b) Adjusted and Unadjusted Odds of Readmission (With IBD without Malnutrition as Reference)
Unadjusted Odds of Readmission	1.46 (95% CI 1.35-1.58)		< 0.01
Adjusted Odds of Readmission	1.41 (95% CI 1.30-1.52)		< 0.01

Table: Adjusted for Age, Charlson Comorbidity Index, Hospital (Location, Teaching status), Insurance status.
IBD: Inflammatory Bowel Disease ; SD: Standard Deviation; AMA : Against Medical Advice; CI: Confidence Interval

Disclosures:

Fnu Faheela indicated no relevant financial relationships.

Umar Hayat indicated no relevant financial relationships.

Maham Waqar indicated no relevant financial relationships.

Muhammad Kamal indicated no relevant financial relationships.

Muhammad Haseeb indicated no relevant financial relationships.

Fnu Faheela, MBBS¹, Umar Hayat, MBBS², Maham Waqar, MBBS³, Muhammad Kamal, MD⁴, Muhammad Haseeb, MD, MSc⁵. A0344 - Impact of Malnutrition on Readmission Rate in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.