title: Thirty-Day Readmission Rate Is High for Hospitalized Patients Discharged With Home Parenteral Nutrition or Intravenous Fluids.
abstract: Reducing hospital readmissions decreases healthcare costs and improves quality of care. There are no published studies examining the rate of, and risk factors for, 30-day readmissions for patients discharged with home parenteral support (HPS).
  
  
  
  Determine the rate of 30-day readmissions for patients discharged with HPS and whether malnutrition and other demographic or clinical factors increase the risk.
  
  
  
  Retrospective review of patients discharged with HPS from the Cleveland Clinic between July 1, 2013, and June 30, 2014, and followed by the Cleveland Clinic Home Nutrition Support Service.
  
  
  
  Of the 224 patients studied, 31.6% (n = 71) had unplanned readmissions within 30 days of hospital discharge. Of these, 21.1% (n = 15) were HPS related, with catheter-related bloodstream infection (n = 5) and dehydration (n = 5) the most common. The majority of patients (84.4%) were diagnosed with malnutrition, but the presence or degree did not influence the readmission rate ( P = .41). According to univariable analysis, patients with an ostomy ( P = .037), a small bowel resection ( P = .002), a higher HPS volume at discharge ( P < .001), and a shorter period between HPS consult and hospital discharge ( P < .026) had a lower risk of 30-day readmission than their counterparts. On multivariable analysis, patients had a higher risk of 30-day readmission if they had a history of heart disease ( P = .048) and for every 1-unit increase in white blood cells ( P = .026).
  
  
  
  Patients discharged with HPS have a high 30-day readmission rate, although most readmissions were not related to the HPS itself. The presence and degree of malnutrition were not associated with 30-day readmissions.
authors.affiliation: 1 Department of Gastroenterology, West Virginia University-Ruby Memorial Hospital, Morgantown, West Virginia, USA.|2 Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Hiren
authors.initials: H
authors.lastname: Vallabh
authors.affiliation: 2 Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Konrad
authors.affiliation: 2 Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: DeChicco
authors.affiliation: 3 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Cresci
authors.affiliation: 3 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: 4 Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ezra
authors.initials: E
authors.lastname: Steiger
authors.affiliation: 3 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Donald F
authors.initials: DF
authors.lastname: Kirby
mesh_terms: D061605:Administration, Intravenous / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000150:complications; D003681:Dehydration / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: 30-day readmission; home nutrition support; home parenteral support; intravenous fluids; nutrition; parenteral nutrition