60 - Characteristics of Readmissions in Children with Chronic Kidney Disease
Sunday, April 24, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 60 Publication Number: 60.341
Leonela Villegas, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Rui Xiao, University of Pennsylvania, Philadelphia, PA, United States; Zubin J. Modi, University of Michigan Medical School, Ann Arbor, MI, United States; Susan Furth, Childrens Hospital of Philadelphia, Philadelphia, PA, United States
Nephrology Fellow Children's Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Children with chronic kidney disease (CKD) have significant morbidity, mortality, and psychosocial needs. Hospitalization rates and readmissions, as markers of morbidity and drivers of costs of care, have been studied extensively in the adult CKD population. However, there is only a single pediatric study on hemodialysis hospitalizations and it demonstrated a readmission rate of 25%. Here we describe pediatric CKD (stages I-V) hospitalizations associated with readmissions across 49 academic centers in the United States.
Objective: To determine 30-day readmission rates in pediatric patients with CKD and characterize demographic and clinical factors associated with a higher risk of readmission.
Design/Methods: Data from the Pediatric Health Information System (PHIS) was utilized to perform a retrospective cohort study that included pediatric patients < 18 years old admitted to a PHIS hospital with a CKD diagnosis between Jan 1, 2016-June 30, 2021. Exclusion criteria included kidney transplant, an index admission resulting in death, or elective readmission. Univariate analysis was performed on demographics, clinical, and socioeconomic factors, as well as a multivariate logistic regression to analyze factors associated within a readmission. Covariates included demographics, patient-level zip code variables, pediatric medical complexity algorithm (PMCA) scores, and index hospitalization severity level (APR-DRG).
Results: A total of 59,396 pediatric patients with 86,341 inpatient encounters were identified. The observed 30-day readmission rate for patients with CKD was 14.5% (8,587). Readmitted patients were more likely to be older, non-White, live in an urban community, and have longer lengths of stay during index admission. Readmitted patients were more likely to have a complex chronic condition and a high severity of illness during their index admission (Table 1). Multivariate logistic regression found that older age (odds ratio (OR) 1.01; CI, 1.00-1.01), Asian (vs White) race (OR 1.21; CI: 1.07-1.36), a longer length of stay (OR 1.002; CI: 1.001-1.002), higher medical complexity category (OR 6.05; CI: 4.6-8.0) and higher APR-DRG severity level (OR 2.6; CI: 2.4-2.9) were associated with 30-day readmissions. Conclusion(s): About 1 of 7 CKD admissions is followed by a readmission within 30 days. Further work includes evaluation of social determinants of health factors and its’ role as a mitigator for readmissions, which can result in identification of modifiable risk factors for high-risk sub-populations. Table 1. Demographic and Clinical Characteristics by Readmission Status