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Abstract

Objective

To determine the 30-day readmission rate after seizure-related discharge in a nationally representative sample, as well as patient, clinical, and hospital characteristics associated with readmission.

Methods

Retrospective cohort study of adults discharged alive from a nonelective hospitalization for epilepsy or seizure, sampled from the Healthcare Cost and Utilization Project's 2014 Nationwide Readmissions Database. Descriptive statistics and logistic regression models were built to quantify and characterize nonelective readmission within 30 days.

Results

A total of 139,800 admissions met inclusion criteria, of which 15,094 (10.8%) were readmitted within 30 days. Patient characteristics associated with readmission included comorbid disease burden (Elixhauser score 2: adjusted odds ratio [AOR] [95% confidence interval (CI)] 1.38 [1.21–1.57]; Elixhauser score 3: AOR 1.52 [1.34–1.73]; Elixhauser score >4: AOR 2.28 [2.01–2.58] as compared to 1) and participation in public insurance programs (Medicare: AOR 1.39 [1.26–1.54]; Medicaid: AOR 1.39 [1.26–1.54] as compared to private insurance). Adverse events (AOR 1.17 [1.05–1.30]) and prolonged length of stay, as well as nonroutine discharge (AOR 1.32 [1.23–1.42]), were also associated with increased adjusted odds of readmission. The most common primary reason for readmission was epilepsy or convulsion (17%).

Conclusions

Patients hospitalized with seizure are frequently readmitted. While readmitted patients are more likely to have multiple medical comorbidities, our study demonstrated that inpatient adverse events were also significantly associated with readmission. The most common reason for readmission was seizure or epilepsy. Together, these 2 findings suggest that a proportion of readmissions are related to modifiable care process factors and may therefore be avoidable. Further study into understanding preventable drivers of readmission in this population presents an opportunity to improve patient outcomes and health.

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Information & Authors

Information

Published In

Neurology®
Volume 92Number 5January 29, 2019
Pages: e429-e442

Publication History

Received: May 2, 2018
Accepted: September 24, 2018
Published online: December 21, 2018
Published in print: January 29, 2019

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

The first author was supported by the Mirowski Family Fund and by an American Epilepsy Society/ Epilepsy Foundation Research and Training Fellowship for Clinicians as well as the Neurologic Clinical Epidemiology Training Grant (T32-NS-061779).

Authors

Affiliations & Disclosures

Leah J. Blank, MD, MPH
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Neurologic Clinical Epidemiology Training Grant (T32-NS- 061779) (2) Pharmacoepidemiology Training Grant (T32-GM-075766)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) AES/EF Research and Training Fellowship for Clinicians (2) Mirowski Family Fund
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
(1) Bristol Myers Squibb, spouse employed by a multinational law firm of whom BMS was a client in 2017-2018.
James A.G. Crispo, PhD
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) ISPE Presenter Travel Award, (3) Canadian Institute of Health Research Travel Award
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Northern Ontario Academic Medicine Association Clinical Innovation Opportunity Award
Stock/stock Options/board of Directors Compensation:
1.
(1) Public Health Sudbury & Districts Board of Health
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Dylan P. Thibault, MS
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kathryn A. Davis, MD, MS
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
Lundbeck
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Lundbeck, UCB
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Eisai
Research Support, Government Entities:
1.
NINDS, R01 NS099346-01, co-investigator, 2016 NINDS K23 NS073801-01, principal investigator, 2016 NIH R01 EB017255, co-investigator, 2014-2016 DARPA N66001-14-2-4032, co-investigator, 2014-2016
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Thornton Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
ARGENTUM PHARMACEUTICALS LLC, MYLAN PHARMACEUTICALS INC., BRECKENRIDGE PHARMACEUTICAL, INC., and ALEMBIC PHARMACEUTICALS, LTD., 2016 (single legal proceeding on behalf of this list of companies)
Brian Litt, MD
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
1. MC10, Inc 2. Blackfynn, Inc 3. Neuropace, Inc
Gifts:
1.
2. For Profit Entity: Consulting for Eisai Pharmaceuticals for new drug
Funding for Travel or Speaker Honoraria:
1.
All Non-profit organizations. 1. Speaker Gordon Research Conference, Mt. Snow, Vermont 2. Grand Rounds Speaker, University of Calgary 3. Speaker, Asilomar Bioelectronics Symposium 4. NSAS Course Host, Venice Italy, Epilepsy, New Technology for the Clinician
Editorial Boards:
1.
1. Editorial Board, Science Translational Medicine
Patents:
1.
1. Flexible electronic devices 2. Intraoperative mapping system for high frequency oscillations 3. Graphene passivation for implants 4. Transparent graphene electronics
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
1. MC10, Inc 2. Blackfynn, Inc
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH 2. DARPA 3. NSF
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1. Brain Research Foundation 2. Brain and Behavior Research Foundation 3. Mirowski Foundation 4. Neil and Barbara Smit 5. Jonathan Rothberg
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
1. MC10, Inc, through the university of Pennsylvania
Royalty Payments, Technology or Inventions:
1.
1. MC10, ∼$1,000/ year
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Allison W. Willis, MD, MS
From the Department of Neurology (L.J.B., J.A.G.C., D.P.T., K.A.D., B.L., A.W.W.), Translation Center of Excellence for Neurological Outcomes Research (D.P.T., A.W.W.), Center for Clinical Epidemiology and Biostatistics (L.J.B., A.W.W.), Department of Biostatistics, Epidemiology and Informatics (A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
I have been an associate editor for the journal Pharmacoepidemiology and Drug Safety in August 2013.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Institutes of Health/NINDS, 1K23NS081087-01 Principle Investigator, 2012-August 31 2016 National Institutes of Health/NINDS, R01 ns099129 Principle Investigator, September 2017- present
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Blank [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

L.J.B., D.P.T., J.A.G.C., and A.W.W. contributed to study concept and design. L.J.B., D.P.T., J.A.G.C., and A.W.W. contributed to data analysis. L.J.B., D.P.T., J.A.G.C., K.A.D., B.L., and A.W.W. contributed to data interpretation, writing the manuscript, and developing the tables/figures.

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