Hospital Readmissions Among People With Sickle Cell Disease.

Abstract

While advances in the management and treatment of sickle cell disease (SCD), the most common inherited disorder in the United States, have improved outcomes, hospital readmissions remain a significant concern. Thirty-day hospital readmissions is a key quality-of-care indicator; however, there are limited contemporary nationally representative data on SCD readmissions. To characterize national trends in SCD-related readmissions in the United States and describe factors associated with readmission among patients with SCD. This cohort study included patients with SCD aged 18 years and older. Patients were identified in the Nationwide Readmissions Database (NRD), an all-payer database of US hospitalizations, using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Data were collected from January 2016 to December 2021 and analyzed from May to September 2024. Readmission was defined as subsequent admission within 30 days of hospitalization discharge using the Centers for Medicare & Medicaid Services methodology. The 30-day all-cause unplanned readmission risk among adults with SCD was estimated, and the trend in 30-day readmissions among adults with and without SCD was assessed by calendar year from 2016 to 2021. Survey-weighted mixed-effect Poisson regressions were used to identify factors associated with readmission. From 2016 to 2021, 140 096 807 all-cause index hospitalizations and 592 951 SCD-related index hospitalizations were analyzed. Patients with SCD had a stable readmission risk of approximately 34% (annual range, 32.6%-34.3%), significantly higher per year than the approximately 12% readmission risk among patients without SCD (annual range, 12.0%-12.2%) (P < .001). In 2021, there were 92 536 index admissions from 37 410 unique patients with SCD (median [IQR] age, 34 [26-46] years; 22 484 [60.1%] female), with 30 467 readmissions. Younger patients (aged 18-29 years) had the highest readmission risk at 35.1%. In multivariable model among patients with SCD, patients from the highest-income zip codes had lower readmission risk than those from lower-income areas (adjusted risk ratio [aRR], 0.90; 95% CI, 0.84-0.97). Admissions paid by Medicare and Medicaid were associated with higher readmission risk than private insurance (Medicare: aRR, 1.67; 95% CI, 1.56-1.78; Medicaid: aRR,1.53; 95% CI, 1.43-1.63). Vaso-occlusive crises at index admission were associated with higher readmission risk (aRR, 1.31; 95% CI, 1.25-1.37). Fewer readmissions were observed in patients receiving simple (aRR, 0.86; 95% CI, 0.82-0.91) and exchange (aRR, 0.78; 95% CI, 0.61-0.99) red blood cell transfusions. In this cohort study with nationally representative data, patients with SCD had a significantly higher readmission risk than patients without SCD. Preventative, disease-modifying, and curative interventions are needed to reduce readmission risks and improve outcomes for patients with SCD.