MON-LB003 Risk Factors For 30-day Readmission After Diabetic Ketoacidosis Using Nationwide Readmissions Database
Authors: Varghese Ron , Jacob Diana , Kamoga Roy , Khasawneh Khaled , Mehta Neal 
Published: May 2019

Abstract
Introduction: Nearly 1 in 10 individuals in the United States have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We sought out to determine the 30-day all-cause readmission rate for adults (age &gt; 18) admitted with DKA and the associated predictors of readmissions. Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) Health Care Utilization Project’s (HCUP) 2014 Nationwide Readmission Database which includes 14.9 Million discharges across 22 states accounting for 51.2% of the total U.S. population and 49.3% of all U.S. hospitalizations to identify admissions with a DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age &gt; 18)with an index hospitalization between January 1 and November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmission including DKA within 30-days of DKA were analyzed. Statistical analysis was completed with Stata 15 (StataCorp, College Station, TX) with p-values &lt; 0.05 considered statistically significant. A univariate and multivariate analysis of data collected was completed using both odds ratio and chi square test for significance. Predictors for readmission were determined using a multivariate logistic regression model following sequential step-wise elimination of covariates including demographics, comorbidities, hospital characteristics, length of stay (LOS) for index admission, and the modified Elixhauser Comorbidity Index. Results: A total of 66,896 patients met criteria for DKA related index admission. Of which, there was 12,954 (19.36%) all-cause readmissions within 30-days including 7,167 were again for DKA accounting for 55.32% of all readmissions. Multivariate analysis showed that the predictors of 30-day readmission were younger age, (with adults age &lt;35 the highest risk), female, disposition at discharge to short term hospital or home health or against medical advice), from a zip code with the lowest income quartile, Medicare as payer, lengthier LOS, presence of comorbidities, absence of obesity, and presence of renal failure. Conclusion: Almost 1 in 5 (19.36%) patients discharged after a DKA admission were readmitted within 30 days. Physician awareness and development of targeted interventions for individuals with risk factors and high-risk for readmissions may help decrease future morbidity and mortality. References: [1] CDC: National Diabetes Statistics Report (2017). https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.