Predictors of Thirty-Day Hospital Readmissions in Systemic Lupus Erythematosus in the United States: A Nationwide Study

Abstract

Objective: To evaluate independent risk factors for readmission and to determine the major reasons for readmission in a nationally representative sample of patients with systemic lupus erythematosus (SLE). Methods: We used the Nationwide Readmissions Database to identify adults with SLE who were discharged from hospital to home during January–November of 2016 and 2017. Thirty-day all-cause readmissions were identified. A multivariable adjusted survey-specific logistic regression model was used to identify factors associated with readmission. Results: A total of 132,400 hospitalized adults with SLE were discharged home during the study period; 88.3% were female, with a median age of 51.0 years (interquartile range 38.7–61.9 years). Of these, 18,973 individuals (14.3%) were readmitted within 30 days of discharge from their index hospitalization. In multivariable analyses, the factors associated with the highest odds for readmission were autoimmune hemolytic anemia (odds ratio [OR] 1.86 [95% confidence interval (95% CI) 1.51–2.29]), glomerular disease (OR 1.27 [95% CI 1.19–1.36]), pericarditis (OR 1.35 [95% CI 1.14–1.60]), heart failure (OR 1.34 [95% CI 1.24–1.44]), age 18–30 years (OR 1.28 [95% CI 1.17–1.41] versus age ≥​65 years), and Medicare (OR 1.20 [95% CI 1.13–1.28]) and Medicaid insurance (OR 1.26 [95% CI 1.18–1.34]). Sepsis (7.6%), SLE (7.4%), heart failure (3.5%), and pneumonia (3.2%) were among the most common causes for readmission. Conclusion: In this nationally representative study of SLE readmissions, the strongest risk factors for 30-day readmission were younger age, SLE-related manifestations, and public insurance. These results identify patient groups with SLE that would benefit from postdischarge interventions designed to reduce hospitalizations and improve health outcomes.