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Study: One in Six Lupus Patients Readmitted to Hospital Within 30 Days of Discharge

Readmissions usually associated with nephritis, serositis, or thrombocytopenia

According to a new study published in Arthritis & Rheumatology, one in six patients with systemic lupus erythematosus (SLE) is readmitted to the hospital within 30 days of being discharged.

The authors found that black and Hispanic SLE patients were more likely to be readmitted than were white patients. Readmissions among patients insured by Medicare or Medicaid were also more likely compared with patients covered by private insurance.

Lupus is a systemic autoimmune disease in which an overactive immune system attacks healthy joints and organs. Medical evidence has shown that up to 25% of SLE patients require hospital treatment each year, accounting for more than 140,000 hospitalizations in the U.S. Moreover, SLE has the sixth highest rate of readmission among all medical conditions in the U.S., according to a 2010 study.

“SLE patients have one of the highest hospital readmission rates compared to those with other chronic illnesses,” explained lead investigator Jinoos Yazdany, MD, MPH, of the University of California, San Francisco. “Our study is the first large-scale examination of early readmissions following hospitalization due to SLE.”

The researchers examined 55,936 hospitalizations using hospital discharge databases that included roughly 85% (810) of U.S. hospitals. The team analyzed data from 31,903 lupus patients readmitted between 2008 and 2009 in five states: California, Florida, New York, Utah, and Washington. The analyses included SLE patients 18 years of age or older who were readmitted to the hospital and excluded hospital transfers, discharges to nursing or rehabilitation facilities, maternity-related admissions, or patients who died.

The results showed that there were 9,244 (17%) hospital readmissions within 30 days of discharge. The readmissions occurred among 4,916 SLE patients. Clinical features most associated with readmission included lupus nephritis, serositis, and thrombocytopenia. Age was inversely related to readmission, suggesting that severe organ involvement in younger SLE patients may be partly to blame.

Further analyses found that risk-adjusted readmission rates were lower in New York and higher in Florida compared with California. Hospitals with higher readmissions for SLE did not have higher admissions for other chronic conditions, such as heart failure or pneumonia, which the authors believe is condition-specific to SLE readmissions and warrants further study.

“The significant geographic and hospital-level variation in readmission rates signals a need for quality improvement efforts in lupus,” Yazdany said.

Sources: Medical Xpress; August 11, 2014; and Arthritis & Rheumatology; August 11, 2014.

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