SLR - June 2019 - Nicholas L. Varakin

Analysis of Readmissions Following Hospitalization for Cellulitis in the United States

Reference: Fisher JM, Feng JY, Tan SY, Mostaghimi A. Analysis of Readmissions Following Hospitalization for Cellulitis in the United States. JAMA Dermatol. 2019 Feb 27. doi: 10.1001/jamadermatol.2018.4650. [Epub ahead of print]

Scientific Literature Review

Reviewed By: Nicholas L. Varakin, DPM
Residency Program: Temple University Hospital, Philadelphia, PA

Podiatric Relevance: A common condition seen and treated by podiatrists in the inpatient setting is cellulitis. A misdiagnosis of cellulitis or sequelae from cellulitis could lead to readmission for the patient. Becoming increasingly aware of and proper management of cellulitis and its sequelae can help minimize the readmission rate and decrease healthcare costs.

Methods: This study was a retrospective cohort analysis. It looked at all admissions from 2014 for patients who were admitted for cellulitis using ICD-9-CM codes. It used the Healthcare Cost and Utilization Project Nationwide Readmission Database. This database allowed the study to look for national estimates via poststratification weighting. Inclusion criteria were adult patients admitted for conditions other than obstetrical or newborn care. Readmission rates, for any reason, were defined as the number of index admissions from January 1 through November 30, 2014 with nonelective readmission within 30 days of index admission.

Results: There were 447,080 admitted for cellulitis during this period, accounting for 2.2 percent of hospital admissions (53.8 percent male, 46.2 percent female). 43.7 percent of the population had Medicare as a primary insurer. The 30-day all-cause readmission rate was 9.8 percent. Readmission for patients 65 years or older was 12.3 percent. This correlates with a rate of 12.8 percent for those who were insured with Medicare. The most common readmission diagnosis was skin and subcutaneous tissue infection followed by diseases of the heart, 29.7 percent and 8.3 percent, respectively. Total cost for readmission in the timeframe listed above totaled $553.3 million, of which $114.4 million was for skin and subcutaneous tissue infections.  

Conclusions: Although the 30-day readmission rate is relatively low, it is important nonetheless to try to minimize this as much as possible, both for the benefit of the patient and to decrease the burden on the healthcare system. A proportion of readmission is likely due to treatment failures, conditions distinct from cellulitis and misdiagnosis/incorrect diagnosis of cellulitis. Therefore, it is important when dealing with cellulitis in a hospital setting to recognize and appropriately treat the condition, seeking outside consultation as needed for complex clinical pictures. 

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