Cellulitis Readmissions Common, Costly, Preventable

By Marilynn Larkin

March 07, 2019

NEW YORK (Reuters Health) - Readmission after hospitalization for cellulitis is "common and costly and may be preventable," researchers say.

"Unfortunately, our data source was not granular enough to understand what the core issues were for each of the patients that led to their readmission (e.g., misdiagnosis, incompletely treated disease, etc.)," Dr. Arash Mostaghimi of Brigham and Women's Hospital in Boston told Reuters Health by email. "However, from other data on cellulitis specifically and readmissions in general we can identify likely areas for improvement."

Dr. Mostaghimi and colleagues analyzed close to 448,000 adults admitted to a hospital with a cellulitis diagnosis (mean age, 56; about 54% men). The overall 30-day nonelective all-cause readmission rate after discharge was 9.8%, according to their JAMA Dermatology report, online February 27.

Readmission rates were 7.0% for patients ages 18 to 44, 9.8% for ages 45 to 64, and 12.3% for those 65 or older.

Rates also were higher for patients insured by Medicare (12.8%) and Medicaid (10.8%) than for privately insured patients (5.7%; odds ratio, 2.03).

Post-cellulitis readmissions cost more than US$500 million, whereas readmissions specifically for skin and subcutaneous infections, the most common readmission diagnosis, cost more than US$100 million.

"Two studies published last year in JAMA dermatology showed the impact of early dermatology consultation for patients with suspected cellulitis in reducing unnecessary admissions and antibiotic use," said Dr. Mostaghimi, who is Associate Editor of the journal.

"Unfortunately, inpatient dermatology consultation is not available everywhere and improved diagnostics may fill that practice gap," he noted. "Some preliminary work has shown that thermal imaging may improve diagnosis."

"Our group also created an easy point-of-care tool called the ALT-70 to help improve patient triage," he said. (http://bit.ly/2UnbYEP) "We are currently determining the validity of teledermatology for improving diagnosis, which may allow dermatologists to provide help in hospitals and primary care offices where dermatologists are currently unavailable."

"Ultimately, a point-of-care diagnostic tool similar to a troponin test for myocardial infarction that separates cellulitis from its mimickers would be ideal," he said.

Dr. Suzanne Friedler, a clinical instructor of dermatology at the Mount Sinai Health System in New York City, said in an email to Reuters Health, "A large number of cellulitis readmissions are due to treatment failure. Optimizing treatment by utilizing a dermatologist and infectious disease experts may lower this number."

Like Dr. Mostaghimi, she noted, "Making sure that suspected cellulitis patients are evaluated by a dermatologist would significantly reduce misdiagnosis."

"Improving the quality of discharge instructions and providing better follow up post-discharge applies to any condition and would benefit these cases as well," she added.

"In this retrospective study, greater readmissions were found in the elderly and Medicare populations and that is easily attributable to their greater comorbidities," Dr. Friedler said. "Future studies should also look at the impact of socioeconomic factors and access to healthcare follow up."

SOURCE: http://bit.ly/2UoAwNN

JAMA Dermatol 2019.