Among patients with systemic lupus erythematosus - the most common form of lupus - 1 in 6 are readmitted to the hospital within 30 days of discharge.
Systemic lupus erythematosus (SLE) is an autoimmune disease whereby the immune system mistakes healthy tissues for foreign invaders and attacks them. This can cause damage to numerous parts of the body, including the skin, joints, kidneys, heart, lungs, blood vessels and brain.
Symptoms of SLE vary depending on what part of the body is affected, but the majority of patients experience joint pain and swelling, with some developing arthritis. Other symptoms include fatigue, fever, hair loss, sensitivity to sunlight, mouth sores and skin rash.
According to the research team, including Dr. Jinoos Yazdany of the Division of Rheumatology at the University of California-San Francisco, studies show that up to 25% of SLE patients need hospital treatment each year, accounting for over 140,000 hospitalizations in the US.
Furthermore, the team points to a 2010 study revealing that patients with SLE have the sixth highest hospital readmission rate in the US, compared with those with other chronic illnesses.
In this latest study, Dr. Yazdany and colleagues set out to gain a more detailed insight into the rate of hospital readmissions for SLE patients and determine the main reasons for readmission.
Readmission rates vary by state and hospital
To reach their findings, the team analyzed hospital discharge databases that provided information for 810 hospitals in the US.
From this, they identified 31,903 SLE patients aged 18 or over from five states (California, Florida, New York, Utah and Washington) who had been treated for the disease and readmitted to the hospital in 2008-09.
The researchers found that 9,244 hospital readmissions among 4,916 SLE patients took place within 30 days of discharge, meaning almost 1 in every 6 SLE patients was readmitted.
Black or Hispanic SLE patients were more likely to be readmitted than white patients, and younger patients were at higher risk of readmission than older patients. Those insured by Medicare and Medicaid were more likely to be readmitted than those who had private insurance.
The medical conditions most likely to cause readmission were lupus nephritis (kidney inflammation), serositis (inflammation of tissues lining the lung, heart, abdomen or abdominal organs) and thrombocytopenia (reduction in blood platelet count).
After adjusting for these risk factors, the team found that readmission rates varied between states. Compared with California, they found readmission rates were higher in Florida and lower in New York.
Furthermore, they found that hospitals that had higher readmission rates for SLE patients did not have higher readmissions for other chronic conditions, such as pneumonia and heart failure.
Commenting on the findings, the researchers say:
"Taken together, our findings regarding both risk factors and variability in 30-day readmissions suggest that readmissions may be an important outcome measure in SLE.
Although our study does not address the reasons for variation in readmission rates between hospitals and states, the presence of unexplained variation after careful risk adjustment suggests that there is room for quality improvement. Further work to identify care processes that can reduce readmission rates for this complex disease is needed."
They admit that the study is subject to some limitations. For example, they only included data from five states, therefore their findings may not be representative nationwide. "However, our study covers a substantial number of admissions among individuals with SLE in the US," they add.
In addition, they note that many states included in the study did not disclose whether hospital admissions were planned or not, meaning some scheduled hospitalizations could have been deemed unplanned.
Earlier this year, Medical News Today reported on a study by researchers from the University of Alabama at Birmingham, revealing the discovery of an immune protein that could pave the way for more personalized lupus treatments.