Nearly 1 in 5 patients hospitalized with atopic dermatitis (AD) are readmitted within 1 year, most commonly for allergic reactions and skin infections, according to study results published in the Annals of Allergy, Asthma and Immunology.
Investigators analyzed a stratified representative cross-sectional sample of all US hospital readmissions from the 2012-2014 National Readmissions Database. The database captured adult and pediatric discharges (N=42,679,001). The first instance of primary discharge International Classification of Diseases, Ninth Revision, Clinical Manifestation diagnosis code 691.8 was used to identify the index hospital admission for AD for each patient. The first readmission for AD at any point in the calendar year was the primary outcome measure. Hospitalizations were examined to determine 30-, 60-, and 90-day readmission rates, determined by the primary discharge diagnosis of subsequent admissions.
Approximately 17% (95% CI, 14%-20%) of patients admitted to the hospital for AD were subsequently readmitted for any reason. Of the 17% readmitted patients, 4.6% (95% CI, 3%-6.1%) were for AD, with a median time to readmission of 41.4 [interquartile range, 72.6] days and 12.5% were for other diagnoses (95% CI, 9.9%-15%), with a median time to readmission of 55.2 [interquartile range, 81.4] days. Rates of readmission for AD increased over 30 days (1.75%; 95% CI, 0.64%-2.86%), 60 days (3.47%; 95% CI, 1.83%-5.11%), and 90 days (3.54%; 95% CI, 1.83%-5.25%). Other than AD, the most common reasons for the first admission at any time in the calendar year were skin and subcutaneous tissue infections (2.07%; 95% CI, 1.09%-3.05%), allergic reactions (1.69%; 95% CI, 0.8%-2.58%), and asthma (0.93%; 95% CI, 0.02%-1.85%). Most of the patients who were readmitted for AD were only readmitted once after the index admission (n=215; 12.53%; 95% CI, 10.2%-14.87%).
This study was limited by the lack of data available in the Nationwide Inpatient Sample for AD severity and phenotypes, outpatient visits, and the treatment regimens employed.
The researchers found that nearly 20% of patients hospitalized with AD were subsequently readmitted for AD and/or other disorders. A small subset of frequent readmissions accounts for a large proportion of expenditures. Future studies are needed to determine the best way to identify the patients who are most at risk for frequent admissions and to determine the therapeutic interventions needed to prevent these admissions and readmissions.
Cheng BT, Silverberg JI. Predictors of hospital readmission in US children and adults with atopic dermatitis [published online April 24, 2019]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2019.04.016