Abstract Details

Title Predictors of 30-day Readmissions and Prolonged Length of Stay Following Hospitalization for Complex Regional Pain Syndrome Type 1 - A 5-year National Estimate

Topic Pain

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

Poster/Presentation
Number 7-061

Objective To evaluate national incidence and predictors of increased 30-day readmission and prolonged length of stay post index hospitalization with CRPS Type-1.

Background Complex Regional Pain Syndrome (CRPS) Type-1, formally known as Reflex Sympathetic Dystrophy, is poorly understood, complex pain disorder characterized by disabling pain, vasomotor instability, sudomotor dysfunction, motor dysfunction and poor short-term outcomes.

Design/Methods Nationwide Readmissions Database (NRD) from 2010-14 was utilized to identify CRPS Type-1(ICD-9CM code 337.2x) in primary diagnostic field. Admissions within 30 days of discharge were considered as early readmission. Predictors to assess association between baseline characteristics, 30-day readmission, and prolonged Length of stay (pLOS) were analyzed using a multivariable logistic regression model.

Results We identified 4,507 patients with CRPS in our study, of which 543 (12.1%) were readmitted within 30 days (Mean age 45.5 ± 15.9 years; 71.3% female). 53.9% hospitalization was with CRPS of lower limb and 29% with CRPS of upper limb. Higher burden of comorbidities (Charlson comorbidity index) was a significant predictor of increased 30-day readmission (OR:1.18, 95% CI:1.03-1.35, p =0.018). Elective admission (OR:0.67, 95% CI:0.49-0.91, p =0.012), private insurance (OR:0.70, 95% CI:0.51-0.96, p=0.029), self-payment (OR:0.45, 95% CI:0.31-0.67, p <0.001) vs Medicaid/Medicare insurance during index hospitalization were significant predictors of decreased readmission. Higher burden of comorbidities (OR:1.23, 95% CI:1.09-1.39, p =0.001), Peripheral vascular disease (OR:2.75, 95% CI:1.54-4.90, p =0.001) were associated with pLOS, whereas elective (OR:0.36, 95% CI:0.27-0.47, p <0.001) and weekend (OR:0.65, 95% CI:0.45-0.94, p =0.022) admission were predictors of decreased LOS.

Conclusions Hospitalization with CRPS was associated with a 12.1% readmission rate during our study period. Predictors of prolonged hospitalization include a higher Charlson comorbidity index, higher burden of comorbidities, and peripheral vascular disease. Identification of high-risk population based on certain preexisting comorbidities and hospital characteristics, better follow up and transition of care can have improved outcomes in these patients and reduce healthcare burden.

Authors/Disclosures
Charles W. Brock, MD PRESENTER	No disclosure on file
Chirag N. Savani, MD (Tampa General Hospital)	No disclosure on file
	No disclosure on file
James R. Ghattas, DO	No disclosure on file
Luiz De Souza, MD (University of South Florida - JAHVAH)	No disclosure on file
Jose R. Rodriguez, MD (University of South Florida - JAHVAH)	No disclosure on file
Matthew Chung, MD (University of Texas, MD Anderson Cancer Center)	No disclosure on file
Grace Kim	Mr. Kim has nothing to disclose.
Tigran Kesayan, MD (VUMC Pain Medicine and Neurology)	Dr. Kesayan has nothing to disclose.
Martin A. Myers, MD (James A Haley VA)	No disclosure on file

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