National Estimates and Predictors for Pulmonary Hypertension Readmission Categorized by Pulmonary Hypertension Subtype

Purpose While hospital readmissions are currently the focus of much scrutiny across other cardiopulmonary diseases, it is relatively understudied within pulmonary hypertension (PH). We sought to determine national estimate measures and predictors of 30-day readmission after PH-related hospitalization categorized by PH diagnostic category. Methods We utilized the 2014 Healthcare Cost and Utilization Project Nationwide Readmission Database (NRD) that accounts for weighted estimates of roughly 35 million discharges in the United States. Adult patients with primary ICD-9-CM diagnosis codes of 416.0 and 416.8 for primary and secondary PH with an index admission and any readmission within 30-days of the index event were identified. Sampling weights were used to obtain national-level estimates. We then sought to assess predictors of 30-day readmission from 29 AHRQ comorbidity measures and categorized them by PH diagnostic category as Primary PH (PPH) and Secondary PH (SPH) using multivariable logistic regression modeling, adjusted for gender, age group, hospital characteristics, and index LOS. Results The national estimate for an overall number of PH related index events with 30-day readmission was 2338 (SE 133) and a national readmission rate estimate 0.20 (SE 0.007). 90% of 30-day readmissions were SPH and 10% were PPH. The presence of fluid and electrolyte disorders (FED) was associated with increased risk of readmission in PPH while predictors of SPH readmissions included anemia, congestive heart failure, lung disease, FED, solid tumor without metastasis and renal failure. The mean charges for PPH admissions and readmissions were $75,980 and $85,842, with SPH totaling $53,084 and $62,585, respectively. Conclusion Roughly, 20% of PH-related hospitalizations result in 30-day readmission with underlying predictors varying by PH type. Furthermore, in adults, mean charges of readmission exceeded that of index hospitalization across both PH diagnostic categories.