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Abstract Background US hospitals are experiencing an increase in admissions for persons who use drugs (PWUD). We examined predictors of two outcomes—leaving AMA and 30-day readmission—among PWUD. Methods We limited… Click to show full abstract
Abstract Background US hospitals are experiencing an increase in admissions for persons who use drugs (PWUD). We examined predictors of two outcomes—leaving AMA and 30-day readmission—among PWUD. Methods We limited the 2013 National Readmissions Database to admissions of PWUD (age 18 to 65; ICD-9 codes for illicit drugs). Diagnoses and severity (Elixhauser comorbidity index (ECI)) were defined by ICD-9 codes. Uni- and multivariable logistic regression were performed. Results Predictors of AMA included younger age, male gender, bacterial infection, overdose, and using more than one drug. Use of opioids with stimulants was associated with the highest rate of AMA discharge (AOR 1.81, 95% CI 1.76–1.86). Leaving AMA was not found to be associated with 30-day readmission (OR 0.99, 95% CI 0.96–1.03). Conclusion PWUD represent a heterogenous patient population with hospital outcomes influenced by different patterns of drug use. Further exploration into these differences could have implications for predicting and intervening to prevent AMA discharges as well as 30-day readmissions, which are associated with worse outcomes and significant healthcare costs. Median [IQR] or N (%), N = 1,773,194 AMA, N = 1,211,883* 30-Day Readmission, N = 1,211,883a OR AOR OR AOR Age 44 [32, 53] 0.98 (0.98, 0.98) 0.983 (0.98, 0.98) 0.999 (0.99, 1.00) – Female 777,920 (44%) 0.71 (0.70, 0.72) 0.64 (0.63, 0.66) 0.93 (0.91, 0.95) 0.93 (0.91, 0.95) Bacterial infection 506,557 (29%) 1.15 (1.13, 1.17) 1.15 (1.12, 1.17) 0.99 (0.97, 1.02) – Overdose 105,291 (6%) 1.18 (1.15, 1.21) 1.15 (1.11, 1.19) 0.91 (0.88, 0.95) 0.90 (0.86, 0.95) AMA 122,447 (7%) NA NA 0.99 (0.96, 1.03) -- Death during first admission 15,728 (1%) NA NA NA NA Drug used Opioids only 356,363 (47%) REF REF REF REF Stimulants only 269,654 (35%) 0.91 (0.89, 0.93) 0.94 (0.92, 0.96) 1.06 (1.03, 1.10) 1.05 (1.02, 1.08) Opioids/alcohol 264,887 (8%) 1.17 (1.14, 1.21) 1.14 (1.11, 1.18) 0.97 (0.92, 1.01) 0.96 (0.92, 1.00) Opioids/sedatives 58,875 (8%) 1.41 (1.37, 1.46) 1.37 (1.32, 1.41) 1.02 (0.97, 1.07) 1.03 (0.98, 1.08) Opioids/stimulants 204,767 (27%) 1.95 (1.89, 2.00) 1.81 (1.76, 1.86) 0.84 (0.80, 0.88) 0.84 (0.80, 0.88) Elixhauser Comorbidity Index 0–1 466,653 (26%) REF REF REF REF 2–3 889,381 (50%) 0.87 (0.86, 0.88) 0.90 (0.88, 0.92) 1.02 (0.99, 1.04) 0.99 (0.96, 1.02) >3 417,159 (24%) 0.66 (0.64, 0.67) 0.70 (0.68, 0.73) 1.05 (1.02, 1.08) 1.00 (0.96, 1.03) aPatients who died during index admission were removed from the logistic regression. Disclosures All authors: No reported disclosures.