Background/Purpose: Giant cell arteritis (GCA) is a large vessel vasculitis with high potential for morbidity leading to frequent hospitalizations and significant economic burden to the healthcare system. The goal of this study is to use Nationwide Readmissions Database (NRD) to determine the 30-day readmission rate of patients that were initially admitted for active GCA, to identify the reasons and predictors for readmission.

Methods: This is a retrospective cohort study using the NRD from 2016 and 2017. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) was used to identify diagnoses. The primary outcome was rate of all-cause readmission within 30 days of discharge for all patients with principle diagnoses of GCA on index admission. Secondary outcomes were principle diagnoses for readmission, predictive factors and resource use. We compared baseline demographics and calculated all-cause 30-day readmission rates in patients who survived their index hospitalization. Proportions were compared using the Fisher exact test, and continuous variables were compared using the Student t-test. Logistic regressions were used for binary outcomes and linear regressions were used for continuous outcomes. Multivariate logistic regression was conducted using Stata, version 16.0 to determine the predictors for readmission. All p-values were two-sided, with 0.05 as the threshold for statistical significance.

Results: There were 4,841 patients admitted for active GCA flares in the NRD from 2016 to 2017, of which 68.7% were female. The mean age was 72.4±11.9 years. The all cause 30-day readmission rate was 13.1%. The 30-day mortality rate was 0.7%. The five most common reasons for readmissions were GCA, acute kidney failure, sepsis, paroxysmal atrial fibrillation, type 2 diabetes mellitus with hyperglycemia. The adjusted odds ratios (aOR) and p-values were calculated and independent predictors of GCA readmission were identified: Coexisting heart failure (aOR 1.63, 95% CI 1.14- 2.34, p= 0.007) and higher Charlson comorbidity score (aOR 1.16, 95% CI 1.08- 1.23, p< 0.001). Discharge from teaching hospitals was associated with lower odds of being readmitted (aOR 0.72, 95% CI 0.55- 0.95, p=0.019). The total hospital days associated with readmission were 3,894 days, with a total healthcare cost of $8.54 million.

Conclusion: This study showed 13.1% of the patients who were initially admitted for active GCA were readmitted within 30 days, creating a significant economic burden. Patients with coexisting heart failure and higher Charlson comorbidity core were significantly more likely to be readmitted.

We should be more cognizant of the poor outcomes and high disease burden of active GCA and its treatment complications which may lead to unnecessary readmission including infection, hyperglycemia and renal failure. More study on preventing GCA readmission is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/thirty-day-readmission-rate-in-patients-who-were-initially-admitted-for-active-giant-cell-arteritis/