TY - JOUR
T1 - Predictors of 30-day readmission in Stevens-Johnson syndrome and toxic epidermal necrolysis
T2 - A cross-sectional database study
AU - Guzman, Anthony K.
AU - Zhang, Myron
AU - Kwatra, Shawn G.
AU - Kaffenberger, Benjamin H.
N1 - Funding Information:
Conflicts of interest: Dr Guzman discloses the receipt of travel reimbursement from Verrica Pharmaceuticals and consulting fees from Cello Health. Dr Kwatra is an advisory board member for Menlo and Trevi Therapeutics, has received grant funding from Kiniksa Pharmaceuticals, and is supported by the Dermatology Foundation. Dr Kaffenberger is an investigator for Biogen, Eli Lilly, and Celgene and is supported by the Dermatology Foundation. Dr Zhang has no conflicts of interest to report.
Publisher Copyright:
© 2019 American Academy of Dermatology, Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Background: The predictors of readmission in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have not been characterized. Objective: To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization. Methods: We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database. Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated. Results: There were 8837 index admissions with SJS/TEN reported; of these, 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45 to 64 years (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.43-2.49), Medicaid insurance (OR, 1.83; 95% CI, 1.48-2.27), and nonmetropolitan hospital admission (OR, 1.67; 95% CI, 1.31-2.13). Associated comorbidities included HIV/AIDS (OR, 2.48; 95% CI, 1.63-3.75), collagen vascular disease (OR, 2.38; 95% CI, 1.88-3.00), and metastatic cancer (OR, 2.16; 95% CI, 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range, $4,788-$16,485). Limitations: The Nationwide Readmissions Database lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations <3 days. Conclusions: Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peridischarge continuity.
AB - Background: The predictors of readmission in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have not been characterized. Objective: To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization. Methods: We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database. Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated. Results: There were 8837 index admissions with SJS/TEN reported; of these, 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45 to 64 years (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.43-2.49), Medicaid insurance (OR, 1.83; 95% CI, 1.48-2.27), and nonmetropolitan hospital admission (OR, 1.67; 95% CI, 1.31-2.13). Associated comorbidities included HIV/AIDS (OR, 2.48; 95% CI, 1.63-3.75), collagen vascular disease (OR, 2.38; 95% CI, 1.88-3.00), and metastatic cancer (OR, 2.16; 95% CI, 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range, $4,788-$16,485). Limitations: The Nationwide Readmissions Database lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations <3 days. Conclusions: Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peridischarge continuity.
KW - Stevens-Johnson syndrome
KW - cost analysis
KW - drug reactions
KW - inpatient dermatology
KW - mortality
KW - readmissions
KW - toxic epidermal necrolysis
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U2 - 10.1016/j.jaad.2019.09.017
DO - 10.1016/j.jaad.2019.09.017
M3 - Article
C2 - 31542405
AN - SCOPUS:85076220170
VL - 82
SP - 303
EP - 310
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 2
ER -