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J Am Acad Dermatol. 2019 Sep 19. pii: S0190-9622(19)32754-9. doi: 10.1016/j.jaad.2019.09.017. [Epub ahead of print]

Predictors of 30-day Readmission in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective, Cross-sectional Database Study.

Author information

1
Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY. Electronic address: anguzman@montefiore.org.
2
Department of Dermatology, Weill Cornell Medicine, New York, NY.
3
Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD.
4
Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH.

Abstract

BACKGROUND:

The predictors of readmission in Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) have not been characterized.

OBJECTIVE:

To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization.

METHODS:

We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database (NRD). Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated.

RESULTS:

A total of 8,837 index admissions with SJS/TEN were reported. A total of 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45-64 years (Odds Ratio [OR] 1.88, 95% confidence interval [CI] 1.43-2.49), Medicaid insurance (OR 1.83, CI 1.48-2.27) and non-metropolitan hospital admission (OR 1.67, CI 1.31-2.13). Associated comorbidities included HIV/AIDS (OR 2.48, CI 1.63-3.75), collagen vascular disease (OR 2.38, CI 1.88-3.00), and metastatic cancer (OR 2.16, CI 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range $4,788 - $16,485).

LIMITATIONS:

The NRD lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations < 3 days.

CONCLUSIONS:

Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peri-discharge continuity.

PMID:
31542405
DOI:
10.1016/j.jaad.2019.09.017

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