Hospital Readmissions High in Sickle Cell Patients, Study Shows

More than a quarter of patients with sickle cell disease (SCD) are readmitted to the hospital within 30 days of being discharged, most often due to sickle cell crisis, according to a recent U.S. nationwide study.

This high rate of readmissions was associated with a significant financial burden on the healthcare system, the researchers said in the study, titled “Epidemiology and Predictors of all-cause 30-Day readmission in patients with sickle cell crisis” and published in the journal Nature Scientific Reports.

Hospital readmissions lead to significant financial costs for healthcare systems and are linked to increased rates of complications and death in patients.

“Understanding the diagnoses and timing of readmissions is critical to formulate interventions to reduce readmissions whereas information on the added economic burden is required for efficient allocation of resources,” the researchers said.

A previous study on the rates of readmission among patients with SCD found that approximately 33.4% of patients are readmitted to the hospital within 30 days. Most patients in this study were readmitted due to a sickle cell crisis (SCC).

There is a lack of accurate information regarding diagnoses at readmission, total costs associated with readmission, and other factors influencing these rates.

To address this, a group of researchers set out to evaluate readmission diagnoses and other factors associated with all-cause seven-day and 30-day readmission after hospitalization for SCC.

They analyzed the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project 2016 Nationwide Readmission Database  to identify patterns of 30-day readmission. They then estimated the percentage and most common readmission diagnoses for patients readmitted both 30 days and seven days after discharge. 

“We focused on readmission risk at 30 days but also estimated 7-day readmission risk to identify a potential period of further vulnerability,” the researchers said.

They also evaluated which risk factors contributed to readmission, as well as the impact of readmission on patient outcomes and the financial burden on healthcare.

In 2016, among the 67,887 discharges, 18,099 (26.9%) were readmitted within 30 days, and 5,166 (7.6%) were readmitted within seven days.

The 30-day readmissions led to an additional 95,445 days of hospitalization, $152 million in total hospitalization costs, and $609 million in total hospitalization charges.

Diagnoses at readmission were largely similar among both 30-day and seven-day readmissions. For both time periods, more than 80% of patients were readmitted due to an SCC.

The average length of stay for readmitted patients was significantly longer (5.3 days), compared with the length of stay at initial hospitalization (4.9 days).

The average cost of hospitalization in readmitted patients was $8,485, which was significantly higher than the cost of the initial hospitalization ($8,064).

Researchers used multivariate statistical analysis to identify the risk factors associated with a higher likelihood of 30-day readmission.

They found that patients ages 18–30 were the most vulnerable group, which was in agreement with previous findings.

“This group is considered at higher risk because outpatient care is not as well organized as compared to the pediatric age group. The care they receive is generally less comprehensive than that to which they were formerly accustomed,” the researchers said.

Other factors such as being discharged against medical advice, having a higher Charlson comorbidity index (a test prediction of 1o-year mortality for a patient who may have a range of coexisting conditions), low socioeconomic status, and admission at high-volume centers were associated with being readmitted to the hospital.

“Among patients hospitalized for SCC, 30-day readmissions were frequent throughout the month post hospitalization and resulted in an enormous financial burden on the United States healthcare system,” the researchers said.

This study highlights several patient- and hospital-related characteristics that can be targeted to lower  readmissions. While not all risk factors can be altered, physicians can identify patients who are at a higher risk of rehospitalization and follow them more closely, according to the researchers.