S1254 Early (30-Day) Readmissions of Spontaneous Bacterial Peritonitis in the United States: A National Challenge

Introduction: Spontaneous Bacterial Peritonitis (SBP) is a serious acute bacterial infection of the ascitic fluid usually seen in patients with liver cirrhosis. Despite aggressive use of prophylactic antibiotics, it is often associated with poor clinical outcomes and subsequent hospital readmissions. In this study, we aimed to assess and compare 30-day (30d) readmissions of SBP with index SBP hospitalizations. Methods: We utilized the National Readmission Database for 2018 to identify all adult (≥18 years) hospitalizations with a primary index diagnosis of SBP and subsequent 30d readmission. Hospitalization characteristics and outcomes for index and 30d readmissions of SBP were highlighted and compared. A multivariate regression analysis was used to determine independent predictors for 30d all-cause readmissions. P-values ≤ 0.05 were considered statistically significant. Results: In 2018, there were 5,797 index admissions for SBP, of which 1,726 (30%) were readmitted within 30d for all causes. Compared to index admissions, 30d readmissions of SBP had a lower mean age (56.1 vs 58.6 years, p< 0.001) with no statistically significant difference for gender and age (Table). Furthermore, 30d readmissions of SBP were associated with significantly higher odds of inpatient mortality (10% vs 4.9%, OR: 2.15, 95% CI: 1.66–2.79, p< 0.001), and mean total hospital charge [$85,031 vs $56,000, OR: 29,032, 95% CI: 12,867–45,197, p< 0.001] compared to index admissions. However, there was no difference in the mean length of stay [6.2 vs 6.8 days, OR: 0.6, 95% CI: -0.1–1.1, p=0.051] between the two groups. Large bed-sized hospitals had a higher proportion of 30d readmissions of SBP (61.9% vs 58.6%, p=0.012) compared to index admissions (Table). The presence of chronic pulmonary disease (aOR: 1.33, 95% CI: 1.07–1.64, p=0.009) and discharge against medical advice (aOR: 1.78, 95% CI: 1.10–2.88, p=0.018) were identified as independent predictors for 30d readmissions of SBP. Conclusion: SBP is associated with poor survival outcomes and high mortality rates despite the use of prophylactic antibiotics. In 2018, 30d all-cause readmission rate for SBP was 30%. Inpatient mortality for 30d readmissions of SBP was more than double of that for index admissions, reflecting a greater severity of disease at readmission and worse prognosis. Patients with chronic pulmonary disease and those that leave the hospital against medical advice on index admission were more likely be readmitted within 30d of index admission. Table 1. - Comparative analysis of hospitalization characteristics for index and 30-day readmissions of spontaneous bacterial peritonitis (SBP) in the United States for 2018 VARIABLE INDEXADMISSION OF SBP* THIRTY-DAYREADMISSION OF SBP* p-value Total Number of Hospitalizations 5,797 1,726 Mean Age (years) ± Standard Error 58.6 ± 0.6 56.1 ± 1.0 p< 0.001 Gender (%) p=0.393 Males 59.4 60.7 Females 40.6 39.3 Age Group (%) p=0.707 Young Adults (18-34 years) 13.8 17.8 Middle Age (35-64 years) 53.3 55.5 Elderly (≥65 years) 32.9 26.7 Hospital Bed Size (%) p=0.012 Small 16.8 13.3 Medium 24.6 24.8 Large 58.6 61.9 *SBP: Spontaneous Bacterial Peritonitis.