Hospital Readmission Rates in Patients With Neuromyelitis Optica Spectrum Disorder

Abstract

ABSTRACT BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an aggressive central nervous system astrocytopathy often resulting in rapid neurologic decline. Patients have recurrent flares that require immunomodulatory therapy for relapse prevention. These patients are usually hospitalized and may need rehospitalization after decline. Hospital readmission rates are important indicators that can be used to gauge health care quality and have direct implications on hospital compensation. This study aims to identify high-risk characteristics of patients with NMOSD that can be used to predict hospital readmissions. METHODS The 2017 Nationwide Readmissions Database was searched for hospital admissions for NMOSD in the United States. All patients with hospital readmission within 30 days of discharge from the index hospitalization were included. RESULTS The 30-day all-cause readmission rate for NMOSD was 11.9% (95% CI, 10.6%-13.3%). Patients aged 65 to 74 years had higher odds of readmission; those with private insurance had decreased odds. Sex did not affect readmission. Several comorbidities, such as respiratory failure, peripheral vascular disease, neurocognitive disorders, and neurologic blindness, were predictive of readmissions. Plasma exchange increased the odds of readmission, whereas intravenous immunoglobulin and immunomodulatory infusions, such as chemotherapies and monoclonal antibodies, did not affect readmission. CONCLUSIONS The most common etiologies for 30-day read-mission were neurologic, infectious, and respiratory. Treatment targeted toward these etiologies may result in reduced overall readmission, thereby decreasing overall disease burden.