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. 2020 Nov 23;10(4):2045894020966889.
doi: 10.1177/2045894020966889. eCollection 2020 Oct-Dec.

Risk factors for 30-day readmission in adults hospitalized for pulmonary hypertension

Priyanka T Bhattacharya  1   2 , Asif M Abdul Hameed  3 , Shubhadeep T Bhattacharya  4 , Julio A Chirinos  2 , Wei-Ting Hwang  1 , Edo Y Birati  2 , Jonathan N Menachem  5 , Saurav Chatterjee  6 , Jay S Giri  2 , Steven M Kawut  1   2 , Stephen E Kimmel  1   2 , Jeremy A Mazurek  2
Affiliations

Risk factors for 30-day readmission in adults hospitalized for pulmonary hypertension

Priyanka T Bhattacharya et al. Pulm Circ. .

Abstract

Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30-day readmission after pulmonary hypertension-related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30-day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension-related index events between 2012 and 2014 with 30-day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384-$85,647) and $41,604.50 (IQR: $22,481.50-$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670-$66,143) and $36,279 (IQR: $19,059-$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30-day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub-types, and identify methods and procedures to minimize readmission risk.

Keywords: Agency for Healthcare Research and Quality; Healthcare Cost and Utilization Project (HCUP); Nationwide Readmission Database; pulmonary hypertension; readmissions.

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Conflict of interest statement

Conflict of interest: J.A.C. has received consulting honoraria from Sanifit, Microsoft, Fukuda Denshi, Bristol Myers Squibb, OPKO Healthcare, Ironwood Pharmaceuticals, Pfizer, Akros Pharma, Merck, Edwards Lifesciences, and Bayer. J.A.C. is named as inventor in the University of Pennsylvania patent for the use of inorganic nitrates/nitrites for the treatment of HF and Preserved Ejection Fraction, and a patent application for the use of novel neoepitope biomarkers of tissue fibrosis in heart failure. S.E.K. has received consulting fees from several pharmaceutical companies, all unrelated to the content of this study. J.A.M has received advisory board honoraria from Actelion Pharmaceuticals and United Therapeutics, speaker honoraria from Abbott and research support from Actelion Pharmaceuticals, Complexa, Corvia Medical and Tenax Therapeutics.

Figures

Fig. 1.
Fig. 1.
Frequency and percentage of 30-day readmissions in pulmonary hypertension.
Fig. 2.
Fig. 2.
Reasons for 30-day readmissions by PH sub-type and clinical classification software categories among those hospitalized with PH. COPD: chronic obstructive pulmonary disease; CCS: Clinical Classification Software; PH: pulmonary hypertension; PPH: Primary Pulmonary Hypertension; SPH: Secondary Pulmonary Hypertension.
Fig. 3.
Fig. 3.
Risk factors for 30-day readmissions in pulmonary hypertension.
See this image and copyright information in PMC

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