Readmission Rates High for Lupus Patients

A new study reveals that a sixth of patients with systemic lupus erythematosus (SLE) discharged from the hospital was readmitted within a month, with underserved minority populations being the most vulnerable.

Researchers at the University of California, San Francisco (UCSF; USA) used hospital discharge databases from five US states to identify patient-level, hospital-level, and geographic predictors of 30-day hospital SLE readmissions between 2008 and 2009. The researchers evaluated each hospitalization as a possible index event leading up to a readmission, accounting for clustering of hospitalizations within patients and within hospitals, and adjusted for hospital case-mix. They also examined factors associated with 30-day readmissions and calculated readmission risk rates.

In all, the researchers examined 55,936 hospitalizations among 31,903 patients with SLE; 16.5% of the hospitalizations resulted in readmission within 30 days. Upon analysis, age was inversely related to risk of readmission; Black and Hispanic patients were more likely to be readmitted, as were those with Medicare. Readmission rates varied between hospitals, as was geographic variation, with rates lower in New York and higher in Florida, as compared to California. Clinical SLE characteristics, including lupus nephritis, serositis, and thrombocytopenia were also associated with readmission. The study was published online on August 11, 2014, in Arthritis & Rheumatology.

“We found that about one in six hospitalized patients with SLE was readmitted within 30 days, with higher rates in historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement,” concluded lead author Jinoos Yazdani, MD, and colleagues. “While more severe cases of many chronic illnesses have higher readmission rates, these findings suggest that SLE patients with these clinical characteristics also warrant more careful attention.”

SLE is an incurable systemic autoimmune disease that can affect any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. The disease occurs nine times more often in women than in men, is also more common in those of non-European descent. SLE is unpredictable, with periods of illness (called flares) alternating with remissions. Treatment of SLE involves preventing flares and reducing their severity and duration when they occur, using corticosteroids and antimalarial drugs.

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