title: Emergency readmission following acute upper gastrointestinal bleeding.
abstract: OBJECTIVE
  To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB).
  
  
  METHODS
  All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated.
  
  
  RESULTS
  A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056-1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264-12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157-5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093-0.649) were found to be independent predictors of postdischarge rebleeding.
  
  
  CONCLUSIONS
  All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.
authors.affiliation: aDepartment of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden bEndoscopy Unit, Digestive Disease Center, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Strömdahl
authors.forename: Johan
authors.initials: J
authors.lastname: Helgeson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D004164:Diphosphonates / Q000627:therapeutic use; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D065840:Protective Factors; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors
chemical_list: D004164:Diphosphonates