Abstract Details

Title Readmissions after Guillain-Barré Syndrome: Nationally Representative Data

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-027

Objective We aim to summarize rates and reasons for readmission after Guillain-Barré Syndrome (GBS).

Background

Complications and relapses often occur after GBS, but there is a lack of nationally representative data. We hypothesized that advanced age, comorbid illness, and respiratory failure would predict readmission. We further examined readmission rates between patients treated with intravenous immunoglobulin (IVIG) versus plasmapheresis (PLEX), and the most common reasons for readmission.

Design/Methods

We identified index adult GBS admissions, comorbid conditions, and reasons for readmission using validated International Classification of Disease, ninth revision codes from the 2013 National Readmissions Database. GBS mimics were excluded. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for 30-day readmission. Kaplan-Meier analysis was used to estimate cumulative risk of readmission up to 1 year.

Results We identified 2,109 patients admitted for GBS, 438 (20.77%) of which were readmitted during 2013. Two hundred fifty-seven readmissions occurred within 30 days from discharge. Age >=60 years did not predict readmission. Patients who received PLEX showed a trend towards more readmissions (OR 1.43, 95% CI 0.999-2.05, p=0.0503). Comorbid respiratory failure (OR 1.70, 95% CI 1.23-2.35, p=0.00140), non-invasive ventilation (OR 2.07, 95% CI 1.18-3.65, p=0.0118), mechanical ventilation (OR 1.45, 95% CI 1.02-2.07, p=0.0401), congestive heart failure (OR 2.14, 95% CI 1.25-3.66, p=0.00570), peripheral vascular disease (OR 2.13, 95% CI 1.08-4.21, p=0.0291), and renal failure (OR 2.00, 95% CI 1.20-3.32, p=0.00780) predicted readmission. Primary diagnoses at rehospitalization were GBS or chronic inflammatory demyelinating polyneuropathy (42.0%), sepsis (3.50%), pulmonary embolism, pneumonia, and urinary infection (each 1.56%). Cumulative risk of readmission at 300 days was 25.8% (SE 1.20%).

Conclusions

GBS carries significant risk of readmission within 30 days and one year. Comorbid illnesses and respiratory complications predict readmission, but further prospective studies are necessary to clarify clinical aspects of GBS cases requiring rehospitalization.

Authors/Disclosures
Mallory N. Luckey, MD PRESENTER	Dr. Roberts has nothing to disclose.
Peter Jin, MD (University of Maryland School of Medicine)	Dr. Jin has nothing to disclose.
Susan Shin, MD (Mount Sinai Hospital)	Dr. Shin has nothing to disclose.
Mandip S. Dhamoon, MD, MPH	Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Faegre Baker Daniels LLP. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wellstar Health System Inc. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Fabiani Cohen & Hall, LLP. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Kramer, Dillof, Livingston & Moore. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Robins Kaplan. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Parker Waichman LLP. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Heidell, Pittoni, Murphy & Bach, LLP.

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