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The Likelihood of Hospital Readmission Among Patients With Hospital-Onset Central Line–Associated Bloodstream Infections

Published online by Cambridge University Press:  20 May 2015

Carolyn J. Khong ,
James Baggs ,
David Kleinbaum ,
Ronda Cochran  and
John A. Jernigan
Carolyn J. Khong
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
James Baggs*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
David Kleinbaum
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Rollins School of Public Health, Emory University, Atlanta, Georgia. (C.K. is now affiliated with CHOC Children’s Hospital, Orange County, California.)
Ronda Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to James Baggs, PhD, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS: A31, Atlanta, GA 30333 (jbaggs@cdc.gov).
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Abstract

OBJECTIVE

To determine whether central line–associated bloodstream infections (CLABSIs) increase the likelihood of readmission.

DESIGN

Retrospective matched cohort study for the years 2008–2009.

SETTING

Acute care hospitals.

PARTICIPANTS

Medicare recipients. CLABSI and readmission status were determined by linking National Healthcare Safety Network surveillance data to the Centers for Medicare and Medicaid Services’ Medical Provider and Analysis Review in 8 states. Frequency matching was used on International Classification of Diseases, Ninth Revision, Clinical Modification procedure code category and intensive care unit status.

METHODS

We compared the rate of readmission among patients with and without CLABSI during an index hospitalization. Cox proportional hazard analysis was used to assess rate of readmission (the first hospitalization within 30 days after index discharge). Multivariate models included the following covariates: race, sex, length of index hospitalization stay, central line procedure code, Gagne comorbidity score, and individual chronic conditions.

RESULTS

Of the 8,097 patients, 2,260 were readmitted within 30 days (27.9%). The rate of first readmission was 7.1 events/person-year for CLABSI patients and 4.3 events/person-year for non-CLABSI patients (P<.001). The final model revealed a small but significant increase in the rate of 30-day readmissions for patients with a CLABSI compared with similar non-CLABSI patients. In the first readmission for CLABSI patients, we also observed an increase in diagnostic categories consistent with CLABSI, including septicemia and complications of a device.

CONCLUSIONS

Our analysis found a statistically significant association between CLABSI status and readmission, suggesting that CLABSI may have adverse health impact that extends beyond hospital discharge.

Infect Control Hosp Epidemiol 2015;36(8):886–892

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 886 - 892
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2013; San Francisco, California; October 2–6, 2013 (poster 187).

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