Background/Purpose: Longitudinal data on trends of Systemic Lupus Erythematous (SLE) readmissions is scarce. Our study aims to study trends of 30-day readmissions of patients admitted for SLE flare in the United States (US) from 2010-2018. We also aim to highlight the most common reasons for 30-day readmissions of patients admitted for SLE flare in the last decade.

Methods: Data were obtained from the Nationwide Readmission Database (NRD). NRD includes nested and weighted discharge data stratified in clusters to produce national estimates. We performed a retrospective 9-year longitudinal trend analysis of NRD 2010 – 2018 databases. Every other year was sampled during the study period. We searched for index hospitalizations for patients aged ≥ 18 years with “principal” diagnosis of SLE using ICD 9 & 10 codes (“7100” & “M32” respectively) for the corresponding year. The principal diagnosis is the main reason for hospitalization, hence index hospitalizations with SLE as the principal diagnosis are defined as SLE flare hospitalizations. Elective and traumatic readmissions were excluded. The 5 most common principal diagnoses or reasons for readmissions for each sampled year were highlighted. Multivariable logistic and linear regression analyses were used to calculate adjusted p-trend for categorical and continuous outcomes, respectively. We adjusted for change in demographics and Charlson comorbidity index (CCI) score over the years. Analysis was performed using STATA, 16.

Results: 30-day readmissions following admissions for SLE flare decreased from 20.3% in 2010 to 17.6% in 2018 (adjusted p-trend=0.009). See Figure 1. Readmission mortality reduced from 2.5% to 2% (adjusted p-trend=0.317, hospital length of stay (LOS) reduced from 6.7 days to 6 days (adjusted p-trend=0.045), and total hospital cost reduced from $15,843 to $14,619 (adjusted p-trend=0.052) from 2010 to 2018. Proportion of readmissions with CCI score ≥3 increased from 42.2% to 54.4% (adjusted p-trend< 0.0001) during the study period. SLE, sepsis and infections were common reasons for 30-day readmissions across the years (table 1).

Conclusion: About 1 in 5 SLE flare admission results in 30-day readmission. 30-day readmissions following hospitalization for SLE flares have reduced in the last decade. Although readmission LOS reduced, CCI score has increased over time. Decreasing readmission rates over time may reflect improved discharge care and outpatient flare management. Infection control strategies are important in reducing 30-day readmissions following admissions for SLE flare.

Table 1: Characteristics and longitudinal trends of 30-day readmissions following index hospitalization for Systemic Lupus Erythematous flare Abbreviations: Readmit: Readmissions, d, days, LOS: Hospital length of stay, Cost: total hospital cost, CCI: Charlson comorbidity index score, USD: United States dollars, yr: years SLE: Systemic Lupus Erythematous, AKI: Acute kidney injury, UTI: Urinary tract infection. p-value < 0.05 is statistically significant. *We included hospitalizations with a "principal" diagnosis of SLE. **Readmission cost for each year was adjusted for inflation using 2018 US dollars according to the medical expenditure panel survey-based factor for hospital care.

Figure 1: Proportion of 30-day readmissions following index admission for SLE flare from 2010_2018

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematous-readmissions-has-reduced-in-the-last-decade-in-the-united-states-a-9-year-longitudinal-study-of-the-nationwide-readmission-database/