Readmission after seizure discharge in a nationally representative sample

Abstract

Objective: To determine the 30-day readmission rate after seizure-related discharge in a nationally representative sample, as well as patient, clinical, and hospital characteristics associated with readmission.

Methods: Retrospective cohort study of adults discharged alive from a nonelective hospitalization for epilepsy or seizure, sampled from the Healthcare Cost and Utilization Project's 2014 Nationwide Readmissions Database. Descriptive statistics and logistic regression models were built to quantify and characterize nonelective readmission within 30 days.

Results: A total of 139,800 admissions met inclusion criteria, of which 15,094 (10.8%) were readmitted within 30 days. Patient characteristics associated with readmission included comorbid disease burden (Elixhauser score 2: adjusted odds ratio [AOR] [95% confidence interval (CI)] 1.38 [1.21-1.57]; Elixhauser score 3: AOR 1.52 [1.34-1.73]; Elixhauser score >4: AOR 2.28 [2.01-2.58] as compared to 1) and participation in public insurance programs (Medicare: AOR 1.39 [1.26-1.54]; Medicaid: AOR 1.39 [1.26-1.54] as compared to private insurance). Adverse events (AOR 1.17 [1.05-1.30]) and prolonged length of stay, as well as nonroutine discharge (AOR 1.32 [1.23-1.42]), were also associated with increased adjusted odds of readmission. The most common primary reason for readmission was epilepsy or convulsion (17%).

Conclusions: Patients hospitalized with seizure are frequently readmitted. While readmitted patients are more likely to have multiple medical comorbidities, our study demonstrated that inpatient adverse events were also significantly associated with readmission. The most common reason for readmission was seizure or epilepsy. Together, these 2 findings suggest that a proportion of readmissions are related to modifiable care process factors and may therefore be avoidable. Further study into understanding preventable drivers of readmission in this population presents an opportunity to improve patient outcomes and health.