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Brief Report
February 27, 2019

Analysis of Readmissions Following Hospitalization for Cellulitis in the United States

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Medicine, Massachusetts General Hospital
  • 4Associate Editor, JAMA Dermatology
JAMA Dermatol. 2019;155(6):720-723. doi:10.1001/jamadermatol.2018.4650
Key Points

Question  What is the national rate of readmission within 30 days of hospital discharge for cellulitis?

Findings  In this nationally weighted, retrospective cohort analysis of US hospital admissions, 9.8% of 447 080 cellulitis admissions were associated with nonelective readmission within 30 days. All-cause, nonelective readmissions after cellulitis discharge cost more than $500 million; readmissions for skin and subcutaneous infections cost more than $100 million.

Meaning  Readmission after hospitalization for cellulitis is common and costly and may be preventable with improved diagnostics, therapeutics, and discharge care coordination.

Abstract

Importance  Cellulitis commonly results in hospitalization. Limited data on the proportion of cellulitis admissions associated with readmission are available.

Objective  To characterize the US national readmission rate associated with hospitalization for treatment of cellulitis.

Design, Setting, and Participants  This retrospective cohort analysis of cellulitis admissions from the nationally representative 2014 Nationwide Readmissions Database calculated readmission rates for all cellulitis admissions and subsets of admissions. The multicenter population-based cohort included adult patients admitted for conditions other than obstetrical or newborn care. Data were collected from January 1 through November 30, 2014, and analyzed from February 1 through September 18, 2018. Bivariate logistic regression models were used to assess differences in readmission rates by patient characteristics. Costs were calculated for all readmissions after discharge from hospitalization for cellulitis (hereinafter referred to as cellulitis discharge) and by readmission diagnosis.

Exposures  Admission with a primary diagnosis of cellulitis.

Main Outcomes and Measures  Proportion of cellulitis admissions associated with nonelective readmission within 30 days, characteristics of patients readmitted after cellulitis discharge, and costs associated with cellulitis readmission.

Results  A total of 447 080 (95% CI, 429 927-464 233) index admissions with a primary diagnosis of cellulitis (53.8% male [95% CI, 53.5%-54.2%]; mean [SD] age, 56.1 [18.9] years) were included. Overall 30-day all-cause nonelective readmission rate after cellulitis discharge was 9.8% (95% CI, 9.6%-10.0%). Among patients with cellulitis, age (odds ratio for 45-64 years, 0.78; 95% CI, 0.75-0.81; P = .001) and insurance status (odds ratio for Medicare, 2.45; 95% CI, 2.33-2.58; P < .001) were associated with increased readmission rates. The most common diagnosis of readmissions included skin and subcutaneous tissue infections. The total cost associated with nonelective readmissions attributed to skin and subcutaneous infections within 30 days of a cellulitis discharge during the study period was $114.4 million (95% CI, $106.8-$122.0 million).

Conclusions and Relevance  Readmission after hospitalization for cellulitis is common and costly and may be preventable with improved diagnostics, therapeutics, and discharge care coordination.

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