Predictors of 30-day readmission in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cross-sectional database study - 28/11/19

Doi : 10.1016/j.jaad.2019.09.017

Anthony K. Guzman, MD ^a,^⁎ , Myron Zhang, MD ^b, Shawn G. Kwatra, MD ^c, Benjamin H. Kaffenberger, MD ^d
^a Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
^b Department of Dermatology, Weill Cornell Medicine, New York, New York
^c Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
^d Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio

^∗Correspondence to: Anthony K. Guzman, MD, 3411 Wayne Ave, 2nd Floor, Ste D, Bronx, NY 10467.3411 Wayne Ave2nd Floor, Ste DBronxNY10467

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Abstract

Background

The predictors of readmission in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have not been characterized.

Objective

To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization.

Methods

We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database. Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated.

Results

There were 8837 index admissions with SJS/TEN reported; of these, 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45 to 64 years (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.43-2.49), Medicaid insurance (OR, 1.83; 95% CI, 1.48-2.27), and nonmetropolitan hospital admission (OR, 1.67; 95% CI, 1.31-2.13). Associated comorbidities included HIV/AIDS (OR, 2.48; 95% CI, 1.63-3.75), collagen vascular disease (OR, 2.38; 95% CI, 1.88-3.00), and metastatic cancer (OR, 2.16; 95% CI, 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range, $4,788-$16,485).

Limitations

The Nationwide Readmissions Database lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations <3 days.

Conclusions

Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peridischarge continuity.

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Key words : cost analysis, drug reactions, inpatient dermatology, mortality, readmissions, Stevens-Johnson syndrome, toxic epidermal necrolysis

Abbreviations used : ABCD-10, CI, NRD, OR, SCORTEN, SJS, TEN

Plan

Methods

Results

Discussion

	Drs Guzman and Zhang contributed equally to this article.
	Reprints not available from the authors.
	Funding sources: None.
	Conflicts of interest: Dr Guzman discloses the receipt of travel reimbursement from Verrica Pharmaceuticals and consulting fees from Cello Health. Dr Kwatra is an advisory board member for Menlo and Trevi Therapeutics, has received grant funding from Kiniksa Pharmaceuticals, and is supported by the Dermatology Foundation. Dr Kaffenberger is an investigator for Biogen, Eli Lilly, and Celgene and is supported by the Dermatology Foundation. Dr Zhang has no conflicts of interest to report.
	IRB approval status: All research activities were performed using publicly available deidentified information, and Institutional Review Board approval was not required.