Readmissions in Patients with Necrotizing Soft Tissue Infections: Continuity of Care Matters

Author(s):
Clara Kit Nam Lai; Christopher Towe; Nimitt Patel; Laura Brown; Jeffrey Claridge; Vanessa Ho

Background:

Necrotizing soft tissue infections (NSTI) are lethal and rapidly progressive infections, typically treated with extensive surgical debridement, and can carry a mortality up to 34%. For patients who survive the index hospitalization, risk factors associated with readmission and delayed mortality are unknown.

Hypothesis:

We hypothesized that readmission to the same hospital where the index admission occurred would be associated with better clinical outcomes compared to readmission to a different hospital.

Methods:

We utilized patients from the 2017 Nationwide Readmissions Database (NRD) with an index admission for NSTI by ICD-10 code in the first 9 months of the year. We identified patient demographic factors, and Elixhauser comorbidities using ICD-10 codes. Index hospitalization mortality and discharge destination were extracted. We identified all-cause 90-day readmissions, whether readmission occurred at the same or different hospital, and identified time from discharge to first readmission. We calculated 90-day readmission rate and utilized survey-weighted logistic regression to identify factors associated with 90-day readmission and death at the first readmission; factors examined included age, sex, initial discharge destination, same-hospital readmission, and payer; regressions were adjusted for hospital rural/urban location and comorbidities.

Results:

We identified 29,401 patients who were admitted with NSTI in the first 9 months of 2017; 2,350 died at the initial hospitalization. Of the 27,051 patients remaining, 8,021 (29.7%) were readmitted within 90 days, and 382 (4.8%) died at readmission. The median time to readmission was 25 days (IQR 10-48), and 27.8% (n=2,229) occurred at a different hospital. Factors associated with readmission via survey-weighted logistic regression included younger age, and discharge to SNF or against medical advice. Factors associated with death at readmission included older age, index discharge to short term hospital or SNF, or readmission occurring at a different hospital from the index admission. (Table)

Conclusions:

Nearly half of readmissions for patients who were admitted for NSTI occurred after 30 days, and more than one-quarter were admitted to different hospitals. Continuity of care is important for these complex patients, as readmission to the index hospitalization was associated with a decreased odds of death at readmission.