Hospitals With High Volume of Epilepsy Cases Had Lower Readmission Rates

The following article is part of conference coverage from the American Epilepsy Society’s Annual Meeting in New Orleans, LA. The Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

NEW ORLEANS — Hospitals treating a high volume of epilepsy cases each year reported fewer seizure-related readmissions than hospitals serving a low volume of epilepsy cases, according to research presented at the American Epilepsy Society 2018 Annual Meeting, held November 30-December 4, 2018. Patients readmitted to the hospital within 30 days of a seizure diagnosis most commonly reported recurrent seizures or mental health disorders.

Investigators of this retrospective study sought to determine the prevalence of seizure-related hospital readmissions and associated risk factors and to classify the most common diagnoses in patients hospitalized for seizures. The study cohort included 98,712 patients from 11 states who were hospitalized between 2009 and 2012 with a primary discharge diagnosis of seizure or convulsions. Study investigators obtained hospital data from the American Hospital Association and community characteristics from the Robert Wood Johnson Foundation. Serial logistic regression models were used to analyze the effect of risk factors on all-cause 30-day readmissions; risk factors were evaluated for patient-, hospital-, and community-level variables.

Of 98,712 participants, 12,881 (14.0%) reported a 30-day hospital readmission; the most common reasons for readmission included epilepsy or convulsions (30.0%), mood disorders (5.0%), psychotic disorders (4.0%), and septicemia (4.0%). On the patient level, readmission was most strongly associated with CNS tumor (OR 2.1; 95% CI, 1.9-2.4), urgent index admission (OR 2.0; 95% CI, 1.9-2.2), psychoses (OR 1.8; 95% CI, 1.7-1.8), or a long hospital stay (8 or more days vs 0-1 days; OR 1.7; 95% CI, 1.6-1.8). 

Hospital-level risk factors showed that index admission for status epilepticus (OR 3.5; 95% CI, 2.6-4.7) and low epilepsy volume (annual epilepsy volumes of 200+ patients vs <50 patients; OR 0.4; 95% CI, 0.3-0.7) were predictors of readmission for status epilepticus but not for all-cause readmissions. Also, younger age (>65 years: ) OR 0.4, 95% CI, 0.3-0.7) and intubation during index hospitalization (OR 1.7, 95% CI, 21.2-2.5) were also “strongly predictive” of readmissions for status epilepticus. Adjusting for variables, the model c-statistic for all-cause readmissions was 0.66.

Although several patient-level factors predicted risk for rehospitalization, the most common reasons for 30-day readmission were recurrent seizures and mental health disorders. A higher volume of epilepsy admissions on the hospital level were notably associated with lower readmissions for status epilepticus, suggesting that delivery of care in epilepsy-related emergencies is implicated in hospital readmission rates.

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Reference

Terman SW, Guterman EL, Betjemann JP, Hill CE, Burke JF. Predictors of 30-day readmission among patients admitted for epilepsy or seizures. Presented at: American Epilepsy Society 2018 Annual Meeting; November 30-December 4, 2018; New Orleans, LA. Poster 460.