Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: one-year follow-up

BACKGROUND AND AIMS: Few studies have investigated predictors for hospital readmission after hip fracture repair. METHODS: In a prospective cohort study we evaluated factors associated with early (within 3 months) and late (between 3-12 months), single and multiple hospital readmission in 236 hip-fractured older adults admitted to an orthopedic unit. Baseline patient characteristics and hospital course (functional and cognitive status, comorbidity, type of fracture, time to surgery, in-hospital stay, complications) were recorded. Hospital readmission over 12 months and ICD-9 principal diagnosis were ascertained from administrative sources. Functional status at the end of the rehabilitation program was assessed by telephone interviews. RESULTS: Seventy-one patients (30.1%) were readmitted to hospital within twelve months of discharge and 22 (9.3%) had two or more readmission. The total number of readmissions was 105, 43 (41%) occurred in the first three months. The most common readmission causes were cardiac, infectious and cerebrovascular; surgical complication accounted for 5.7%. Patients with a single readmission, like those with multiple readmissions, were sicker (CIRS-CI subscore 4.0+/-1.8 vs 3.2+/-1.6, p=0.010) and more functionally impaired at the end of rehabilitation (2 months' Katz index 2.1+/-2 vs 2.9+/-2.3, p=0.007) than controls. In a multiple logistic regression model, comorbidity and functional status at the end of rehabilitation were the only factors associated with the risk of readmission. CONCLUSIONS: Subjects at high risk of readmission can be reliably assessed, since few significant variables were associated with rehospitalization. Subgroups of patients with an elevated risk of rehospitalization after hip fracture may be the target for strategies to reduce the burden of excessive hospital use and improve overall outcomes.     

Risk factors for early unplanned hospital readmission in the elderly

STUDY OBJECTIVE: To determine the prevalence of early (in 14 days or less) readmissions to the hospital, and to identify risk factors for readmission. DESIGN: Matched case-control. Cases (n = 155) were readmitted to the hospital within 14 days of a hospital discharge, while controls (n = 155) were not. Controls and cases were matched by week of hospital discharge. PATIENTS: Two-year sequential sample of male veterans aged 65 years and over admitted to the Seattle Veterans Affairs (VA) Medical Center. MEASUREMENTS: Data about 31 potential risk factors were abstracted from the medical records. RESULTS: Three risk factors associated with readmission risk were identified and include two or more hospital admissions in the previous year [odds ratio (OR) = 3.06], any medication dosage change in the 48 hours prior to discharge (OR = 2.34), and a visiting nurse referral for follow-up (OR = 2.78). One protective factor--discharge from the geriatric evaluation unit (GEU) (OR = 0.09)--was also determined. CONCLUSIONS: Early unplanned readmissions were frequent at this VA facility. Since the strongest risk factor for readmission was the number of admissions in the previous year, readmissions appeared most commonly among high utilizers of inpatient VA care. This risk factor and others may be useful in identifying a group at high readmission risk, which could be targeted in intervention studies. The reduced readmission rate associated with the GEU suggests one potential intervention to decrease readmission risk.     

The readmission of elderly people to hospital in an inner-city health district

The hospital sector in Britain has, over the last decade, achieved substantial reductions in the average length of stay for patients aged 65 and over. One consequence of this may be increased readmission rates. Furthermore, readmission rates are increasingly being proposed as a surrogate measure of outcome after hospital treatment. All admissions of people aged 65 + to two inner-London hospitals in May 1988 were monitored for 6 months after discharge and readmission rates calculated. Of the 386 patients discharged, 130 (38%) were readmitted within 6 months. The 1 week readmission rate was 6%; at 1 month it was 18%. Readmissions showed no variation regarding age or sex of patients but were related to specialty of treatment and length of stay. Consistently, those readmitted has a shorter length of stay than those not readmitted. If readmission rates are to have any utility as a surrogate outcome indicator they must be calculated on a common basis which relates to unplanned readmissions occurring fairly rapidly after discharge, and are related to the index admission.     

Readmissions after colorectal surgery cannot be predicted

INTRODUCTION: Readmission after discharge from the hospital is an undesirable outcome. In an attempt to prevent unplanned readmissions after abdominal or perineal colon resection, we proposed to identify risk factors associated with return to the hospital. METHODS: Study participants consisted of 249 patients who were operated on from July 1, 1996, to March 30, 1998. All patients who were readmitted within 90 days of discharge from the hospital after surgery were evaluated for the study. A retrospective review of charts was performed to assess whether readmission within 90 days was a direct consequence of the recent operation (unplanned related readmission). These patients were compared with a control group consisting of patients who were never readmitted or who were readmitted with an unrelated problem. RESULTS: Of the 249 patients, 59 (24 percent) were readmitted within 90 days of discharge from the hospital. Twenty-two (9 percent) were unplanned related readmissions. Ten patients were readmitted with unrelated emergencies, and 27 patients were readmitted electively. In the unplanned related group, there was no correlation between age, gender, admission diagnosis, activity status, or postoperative length of stay and the likelihood of readmission. Patients with multiple chronic medical problems or those who developed postoperative complications did not have a higher readmission rate. Patients with ulcerative colitis or those who underwent abdominoperineal resection or total/subtotal colectomy had a higher incidence of readmissions, although the difference was not significant. The mean interval between discharge from the hospital and readmission with a related complication was 19 days. Small-bowel obstruction was the most common reason for readmission, and all cases resolved with conservative management. Mean length of stay during all readmissions was 8 days. CONCLUSION: The incidence of unplanned related readmissions 90 days after abdominal or perineal colon resection is 9 percent, and these readmissions could not be predicted from the postoperative course. Because 82 percent of unplanned readmissions occurred within 30 days, this time frame is suitable for computerized comparative analysis.     

Predictors of early hospital readmission in HIV-infected patients with pneumonia

OBJECTIVE: Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia in Vancouver, Canada. DESIGN: Case-control study. SETTING: Tertiary care, university-affiliated, inner-city hospital. PARTICIPANTS: All HIV-infected patients who were hospitalized with Pneumocystis carinii pneumonia (PCP) or bacterial pneumonia (BP) between January 1997 and December 2000. Case patients included those who had early readmissions, defined as being readmitted within 2 weeks of discharge (N = 131). Control patients were randomly selected HIV-infected patients admitted during the study period who were not readmitted within 2 weeks of discharge (N = 131), matched to the cases by proportion of PCP to BP. MEASUREMENTS: Sociodemographic, HIV risk category, and clinical data were compared using chi2 test for categorical variables, and the Wilcoxon rank-sum test was used for continuous variables. Multivariable logistic regression was performed to determine the factors independently associated with early readmission. We also reviewed the medical records of 132 patients admitted to the HIV/AIDS ward during the study period and collected more detailed clinical data for a subanalysis. MAIN RESULTS: Patients were at significantly increased odds of early readmission if they left the hospital against medical advice (AMA) (adjusted odds ratio [OR], 4.26; 95% confidence interval [95% CI], 2.13 to 8.55), lived in the poorest urban neighborhood (OR, 2.03; 95% CI, 1.09 to 3.77), were hospitalized in summer season (May though October, OR, 2.36; 95% CI, 1.36 to 4.10), or had been admitted in the preceding 6 months (OR, 2.55; 95% CI, 1.46 to 4.47). Gender, age, history of AIDS-defining illness, and injection drug use status were not significantly associated with early readmission. CONCLUSIONS: Predictors of early readmission of HIV-infected patients with pneumonia included: leaving hospital AMA, living in the poorest urban neighborhood, being hospitalized in the preceding 6 months and during the summer months. Interventions involving social work may address some of the underlying reasons why these patients leave hospital AMA and should be further studied.     

Risk factors for early hospital readmission in a select population of geriatric rehabilitation patients: the significance of nutritional status.

OBJECTIVE: To test the strength of the evidence in favor of the hypothesis that protein-energy undernutrition is an independent risk factor for non-elective hospital readmission within 3 months of discharge in a population of elderly hospitalized patients. DESIGN: Retrospective analysis of data from prospective observational study. METHODS: All 110 elderly patients admitted to a geriatric recuperative care and rehabilitation unit during a 6-month period completed a comprehensive in-patient evaluation. Ninety-eight of these patients were subsequently discharged alive and followed prospectively for 3 months. All hospital readmissions during the observation period were identified by patient interview and, within the VA hospital system, computer tracking of admissions. Based on the discharge assessment, the strongest predictors of non-elective readmission were identified using univariate and multivariate statistical procedures. RESULTS: Twenty-eight of the 98 patients discharged alive and completing the 3-month follow-up (29%) had at least one non-elective readmission. The patients discharged home were non-electively readmitted more frequently than were the patients discharged to a nursing home (32% vs 11%, P = 0.05). Of the 109 discharge assessment variables analyzed, the best predictor of which patients would have at least one non-elective hospital readmission was the discharge serum albumin, followed by a diagnosis of dementia, discharge gamma globulin, the subscapular skinfold thickness, home ownership, and the discharge Katz Index of ADL score. Discharge serum albumin concentration, subscapular skinfold thickness, and discharge serum gamma globulin concentration were all negatively correlated with risk of non-elective readmission. The presence of functional debilitation or dementia was associated with a lower likelihood of non-elective readmission compared with the absence of these conditions. CONCLUSIONS: Protein-energy undernutrition appears to be a strong independent risk factor for non-elective hospital readmission especially among the highest risk patients, those who are functionally independent and cognitively intact.     

Quality of care and hospital readmission in congestive heart failure: An explicit review process

BACKGROUND: The effect of hospital quality of care on hospital readmission for patients with congestive heart failure (CHF) has not been widely studied. METHODS AND RESULTS: We examined the effects of clinical factors, hospital quality of care, and cardiologist involvement on 3-month readmission rates in patients with CHF by using a 125-item explicit review instrument comprising 3 major domains: admission work-up, evaluation and treatment, and readiness for discharge. During the 3 months after discharge, 59 (30%) of 205 patients were readmitted for CHF. The average evaluation and treatment score was lower for readmitted patients (63% v 58%; P = .04). The specific quality criteria differing between patients readmitted or not readmitted included the performance of any diagnostic evaluation, performance of echocardiography in patients with unknown ejection fraction or suspected valvular disease, and therapy with an angiotensin-converting enzyme inhibitor on discharge. Patients with 相似文献   

Hospital readmissions among the elderly

This paper investigates the six-month hospital readmission rates among 444 patients 65 years of age or older admitted to a large metropolitan teaching hospital who had a primary discharge diagnosis of cerebrovascular disease, hip fracture, or congestive heart failure. Twenty-four percent were readmitted to the same institution one or more times during the six-month follow-up. Striking variability was observed in use of hospitals across these diagnostic groups. Patients with a primary diagnosis of congestive heart failure were at highest risk of hospital readmission (36%). Multiple readmissions among the congestive heart failure group were prevalent. These preliminary data suggest that hospital readmission among the aged is a complex multifaceted phenomena.     

Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort

Introduction and aimConsidered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort.Material and methods.We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs.Results1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p < 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1-month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score >14 at discharge and serum sodium < 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001).ConclusionsHigh rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.     

Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems

With growing awareness of medical fallibility, researchers need to develop tools to identify and study medical mistakes. We examined the utility of hospital readmissions for this purpose in a prospective case-control study in a large academic medical center in Israel. All patients with nonelective readmissions to 2 departments of medicine within 30 days of discharge were interviewed, and their medical records were carefully examined with emphasis on the index admission. Patient data were compared to data for age- and sex-matched controls (n = 140) who were not readmitted. Medical records of readmitted and control patients were blindly evaluated by 2 senior clinicians who independently identified potential quality of care (QOC) problems during the index admission. Inhospital and late mortality was determined 6 months after discharge.Over a period of 3 months there were 1988 urgent admissions; 1913 discharges and subsequently 271 unplanned readmissions occurred (14.1% of discharges). Readmissions occurred an average of 10 days after discharge, and readmitted patients were sicker than controls (mean, 4.3 vs. 3.3 diagnoses per patient), although their length of stay was similarly short (3.4 +/- 2.8 d). Analysis of all readmissions revealed QOC problems in 90/271 (33%) of readmissions, 4.5% of hospitalizations. All were deemed preventable. Interobserver agreement was good (83%, kappa = 0.67). Among matched controls, only 8/140 admissions revealed QOC problems (6%, p < 0.001) (k = 0.77). The preventable readmissions mostly involved a vascular event or congestive heart failure; they occurred within a mean of 10 +/- 8 days of the index admission, and their inpatient mortality was 6.7% vs. 1.7% among readmissions that had no QOC problems (odds ratio, 4.1; 95% confidence interval, 1.0-16.7). The main pitfalls identified during the index admission included incomplete workup (33%), too short hospital stay (31%), inappropriate medication (44%), diagnostic error (16%), and disregarding a significant laboratory result (12%). In many patients more than 1 pitfall was identified (mean, 1.5 per patient). Risk factors for preventable readmission include older age and living in an institution (p < 0.05). Almost two-thirds of the readmitted patients with QOC problems were discharged after spending 2 days or fewer at the hospital. In conclusion, unplanned readmissions within 30 days of discharge are frequent, more prevalent in sicker patients, and possibly associated with increased mortality. In a third of readmitted patients a QOC problem can be identified, and these problems are preventable. Thus, readmission may be used as a screening tool for potential QOC problems in the department of medicine. Routine monitoring of all readmissions may provide a simple cost-effective means of identifying and addressing medical mistakes.     

Etiologies,predictors, and economic impact of readmission within 1 month among patients with takotsubo cardiomyopathy

Background

Limited data exist on readmission among patients with takotsubo cardiomyopathy (TC), a commonly reversible cause of heart failure.

Hypothesis

We sought to identify etiologies and predictors for readmission among TC patients.

Methods

We queried the National Readmissions Database for 2013–2014 to identify patients with primary admission for TC using ICD‐9‐CM code 429.83. Patients readmitted to hospital within 1 month after discharge were further evaluated to identify etiologies, predictors, and resultant economic burden of readmission. Additionally, we analyzed readmission for TC at 6 months.

Results

We studied 5997 patients admitted with TC, of whom 1.2% experienced in‐hospital mortality. Median age was 67 years, with 91.5% being female. Among survivors, 10.3% were readmitted within 1 month; 25% of the initial 1‐month readmissions occurred within 4 days, 50% within 10 days, and 75% within 20 days from discharge. The most common etiologies for readmission were cardiac (26%), respiratory (16%), and gastrointestinal (11%) causes. Heart failure was the most common cardiac etiology. Significant predictors of increased 1‐month readmission included systemic thromboembolic events, length of stay ≥3 days, and underlying psychoses. Obesity and private insurance predicted lower 1‐month readmission. The annual national cost impact for index admission and 1‐month readmissions was ≈$112 million. Recurrent TC was seen among 1.9% of patients readmitted within 6 months.

Conclusions

Though the overall rate of 1‐month readmission following TC is low, associated economic burden from readmission is still significant. Patients are readmitted mostly for noncardiac causes. Readmission for another episode of TC within 6 months was uncommon.     

Risk factors for early hospital readmission in patients with AIDS and pneumonia

OBJECTIVE: To determine risk factors for early readmission to the hospital in patients with AIDS and pneumonia. DESIGN: Case-control analysis. SETTING: A municipal teaching hospital serving an indigent population. PATIENTS: Case patients were all AIDS patients hospitalized with Pneumocystis carinii pneumonia or bacterial pneumonia between January 1992 and March 1995 who were readmitted for any nonelective reason within 2 weeks of discharge (n = 90). Control patients were randomly selected AIDS patients admitted during the study period who were not early readmissions (n = 87), matched by proportion of Pneumocystis carinii to bacterial pneumonia. MEASUREMENTS AND MAIN RESULTS: Demographics, social support, health-related behaviors, clinical aspects of the acute hospitalization, and general medical status were the main predictors measured. RESULTS: Patients were at significantly increased risk of early readmission if they left the hospital unaccompanied by family or friend (odds ratio [OR] 4.76; 95% confidence interval [CI] 2.06, 11.0; p =.0003), used crack cocaine (OR 3.40; 95% CI 1.02, 11.3; p =. 046), had one or more coincident AIDS diagnoses (OR 3.65; 95% CI 1. 44, 9.26; p =.0065), or had been admitted in the preceding 6 months (OR 2.82; 95% CI 1.21, 6.57; p =.016). Demographic characteristics, alcoholism, intravenous drug use, illness severity on admission, and length of hospitalization did not predict early readmission. CONCLUSIONS: Absence of companion at discharge and crack use were important risk factors for early readmission in patients with AIDS and pneumonia. Additional AIDS comorbidity and recent antecedent hospitalization were also risk factors; however, demographics and measures of acute illness during index hospitalization did not predict early readmission.     

Burden of 30-Day Readmissions After Percutaneous Coronary Intervention in 833,344 Patients in the United States: Predictors,Causes, and Cost: Insights From the Nationwide Readmission Database

Objectives

This study aimed to examine the 30-day unplanned readmissions rate, predictors of readmission, causes of readmissions, and clinical impact of readmissions after percutaneous coronary intervention (PCI).

Unplanned readmissions of patients with congestive heart failure: do they reflect in-hospital quality of care or patient characteristics?

PURPOSE: To determine if early unplanned readmissions of patients hospitalized for heart failure are associated with suboptimal in-hospital care or with the clinical and demographic characteristics of the patient. SUBJECT AND METHODS: We performed a case-control study among patients discharged with a principal diagnosis of heart failure. Cases included all patients unexpectedly readmitted within 31 days of discharge; controls were randomly selected from among those not readmitted. Quality of care was measured using explicit criteria reflecting the admission work-up, evaluation and treatment, and readiness for discharge. RESULTS: Ninety-one cases and 351 controls were included. There was no significant association between early unplanned readmissions and the scores for quality of the admission work-up or evaluation and treatment during the stay. There was a significant association between readiness for discharge and subsequent early readmission: for each 10% decrease in the proportion of fulfilled criteria, the odds of readmission increased by 14% (95% confidence interval [CI] 1. 01 to 1.28, P = 0.04) for all-cause readmissions and by 19% (95% CI: 1.04 to 1.36, P = 0.01) for heart-failure-related readmissions. In a multiple logistic regression model, previous diagnosis of heart failure (odds ratio [OR] = 2.9, 95% CI: 1.7 to 4.8, P <0.001), age (OR = 3.3, 95% CI: 1.3 to 8.5, P = 0.01 for patients aged 65 to 79 years and OR = 4.1, 95% CI: 1.6 to 11, P = 0.004 for patients aged 80 years and older), and history of cardiac revascularization (OR = 2.1, 95% CI: 1.2 to 3.9, P = 0.01) showed a stronger association with early unplanned all-cause readmissions than the readiness-for-discharge score (OR = 1.16, 95% CI: 1.02 to 1.31, P = 0.02). Similar findings were seen for heart failure-related readmissions. CONCLUSIONS: Among patients with heart failure, early unplanned readmissions were not associated with suboptimal admission work-up or evaluation and treatment but were weakly associated with readiness for discharge. However, they were strongly associated with the patients' clinical and demographic characteristics.     

Patient relocation in the 6 months after hip fracture: risk factors for fragmented care

OBJECTIVES: To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes. DESIGN: Prospective cohort study. SETTING: Four hospitals in the New York metropolitan area. PARTICIPANTS: A total of 562 patients hospitalized for hip fracture discharged alive in 1997 to 1998. MEASUREMENTS: Patient characteristics and hospital course were ascertained using patient or surrogate interview, research nurse assessment, and medical record review. Patient location was ascertained at five time points using patient or surrogate interview, and hospital readmissions were identified using New York state and hospital admission databases. Mobility was measured using patient or surrogate report using the Functional Independence Measure. RESULTS: During 6 months of follow-up, the mean number of relocations per patient+/-standard deviation was 3.5+/-1.5 (range 2-10). Forty-one percent of relocations were between home and hospital, 36% between rehabilitation or nursing facility and hospital, 17% between rehabilitation or nursing facility and home, and 4% between two rehabilitation/nursing facilities. In a Poisson regression model that controlled for patient characteristics, hospital course, and length of follow-up, factors associated with relocation (P<.05) were absence of dementia, in-hospital delirium, one or more new impairments at hospital discharge, hospital discharge other than to home, and not living at home alone prefracture. Relocation was not significantly associated with immobility or mortality at 6 months (odds ratio=1.14, 95% confidence interval=0.97-1.35). CONCLUSION: Subgroups of patients with elevated risk of relocation after hip fracture may be target groups for intensive care coordination and care planning interventions.     

Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study

BackgroundHigh rates of unplanned hospital readmissions are a burden on healthcare systems and individuals. This study examined factors at, and after initial hospital discharge and their associations with unplanned hospital readmission for older adults up to six months post-discharge from subacute care.MethodsOlder subacute care patients were surveyed prior to discharge, and assessed monthly post-discharge for six months. Data included the Geriatric Depression Scale, Phone-Fitt sub-scales, Friendship Scale, modified Lubben Social Network Scale, unplanned hospital readmission, self-reported physical capacity and falls in the last month were collected. Regression analyses were used to examine relationships between unplanned hospital readmission and variables that may predispose this outcome.ResultsParticipants (n = 311) completed the baseline assessment. N = 218 (70%) completed all at six-month post-discharge. Eighty-nine (29%) participants shared 143 readmissions. Those with cancer history (adjusted OR [95% CI]) (1.97 [1.15, 3.39]), neurological disease other than stroke (2.95 [1.32, 6.57]) and dependence on others to assist in bending tasks (1.94 [1.14, 3.29]) at initial discharge were associated with readmission within six months post-discharge. Those who fell in the last month (adjusted OR [robust 95% CI]) (2.28 [1.43, 3.64]), being less physical active (0.98 [0.96, 0.99]), and dependence on others in moving around residence (2.63 [1.37, 5.06]) after initial discharge were associated with a readmission in the next month within six months post-discharge.ConclusionTrials investigating the effectiveness of strategies to reduce falls, build physical capacity, increase physical activity level, and connection with health care services after discharge to prevent readmission are warranted.     

Readmission following pancreatectomy: what can be improved?

Background: Readmissions after pancreatectomy, largely for the management of complications, may also occur as a result of failure to thrive or for diagnostic endeavours. Potential mechanisms to reduce readmission rates may be elucidated by assessing the adequacy of the initial disposition and the real necessity for readmission.Methods: Using previously identified categories of readmission following pancreatectomy, details of reasons for and results of readmissions were scrutinized using a root cause analysis approach.Results: Of 658 patients subjected to pancreatectomy between 2001 and 2010, 121 (18%) were readmitted within 30 days. The clinical course in 30% of readmitted patients was found to deviate from the pathway assumed on the initial admission. Patients were readmitted at a median of 9 days (range: 1–30 days) after initial discharge and had a median readmission length of stay of 7 days (mode = 4). Postoperative complications accounted for most readmissions (n = 77, 64%); 17 patients (14%) were readmitted for failure to thrive and 16 (13%) for diagnostics. Root cause analysis detailed subtextual reasons for readmission, including, for example, the initiation of new medications that could potentially have been ordered in an outpatient setting.Conclusions: More than one quarter of readmissions after pancreatectomy occurred in the setting of failure to thrive or for diagnostic evaluation alone. Root cause analysis revealed potentially avoidable readmissions. The development of a system for stratifying patients at risk for readmission or the failure of the initial disposition, along with an alternative means of efficiently evaluating patients in an outpatient setting, could limit unnecessary readmissions and resource utilization.     

Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure

PURPOSE: Among patients admitted for treatment of heart failure, we aimed to evaluate the value of B-type natriuretic peptide levels in predicting subsequent death or hospital readmission. SUBJECTS AND METHODS: We observed and followed 50 consecutive patients admitted with decompensated heart failure. B-type natriuretic peptide levels were measured using an immunofluorometric assay at admission and at discharge. We followed patients for 6 months and ascertained readmissions for cardiovascular causes and death. RESULTS: Forty-three patients were discharged. There were 20 events during follow-up (15 readmissions and 5 deaths). Mean (+/- SD) B-type natriuretic peptide levels decreased during the initial hospitalization, from 619 +/- 491 pg/mL to 328 +/- 314 pg/mL (P <0.001) among patients who were event free during follow-up, whereas declines were less marked among patients with hospital readmission or death (from 779 +/- 608 pg/mL to 643 +/- 465 pg/mL, P = 0.08). Among the 7 patients with in-hospital increases in B-type natriuretic peptide level, 6 had events, compared with 14 of the 36 patients whose levels declined (P = 0.04). An increase in B-type natriuretic peptide levels during hospital stay was associated with an increased event rate (hazard ratio [HR] = 3.3; 95% confidence interval [CI]: 1.3 to 8.8). Patients whose B-type natriuretic peptide level at discharge was above the median (321 pg/mL) had a somewhat higher rate of dying or being readmitted (HR = 2.3; 95% CI: 0.9 to 5.8). CONCLUSION: These preliminary results in a small number of patients suggest that changes in B-type natriuretic peptide levels, as well as predischarge levels, are related to hospital readmission and death within 6 months.     

Frequent hospital readmissions for acute exacerbation of COPD and their associated factors

OBJECTIVE: The factors that determine frequent hospital readmissions for acute exacerbations of COPD (AECOPD) are poorly understood. The aim of this study was to ascertain rates of re-hospitalizations for AECOPD patients and evaluate factors associated with frequent readmissions for acute exacerbations. METHODS: We conducted a cross-sectional survey of 186 patients with moderate to severe COPD with one or more admissions for acute exacerbations to two large general hospitals. Frequency of previous readmissions for AECOPD in the past year, and clinical characteristics, including depression and spirometry were ascertained in the stable state both before discharge and at 1-month post discharge. RESULTS: Among them, 67% had one or more previous readmission, 46% had two or more, 9% had 10-20 readmissions in the 1-year period prior to current admission. There was a high prevalence of current or ex-heavy smokers, underweight patients, depression and consumption of psychotropic drugs, and low prevalence of caregiver support, pulmonary rehabilitation and influenza and pneumococcal vaccination. Univariate analysis showed that male sex, duration >5 years, FEV(1) < 50% predicted, use of psychotropic drugs, receipt of pulmonary rehabilitation and vaccination were significantly associated with frequent past readmissions. Multivariate analysis revealed that disease duration >5 years (odds ratio (OR) = 2.32; 95% confidence interval (CI): 1.09-4.92), FEV(1) < 50% predicted (OR = 2.60; 95% CI: 1.18-5.74), use of psychotropic drugs (OR = 13.47; 95% CI: 1.48-122.92) and vaccination status (OR = 3.27; 95% CI: 1.12-9.57) were independently associated with frequent readmissions for AECOPD. CONCLUSION: Frequent past readmission for AECOPD was associated with disease severity and psychosocial distress and increased use of vaccinations.     

Predictors and impacts of hospital readmissions following liver transplantation

While liver transplantation is the definitive therapy for end stage liver disease, it remains a major procedure, with many potential complications. Hospital readmissions after the initial hospitalization for liver transplantation can be associated with adverse outcomes, increased cost, and resource utilization. Our aim was to define the incidence and reasons for hospital readmission after liver transplant and the impact of readmissions on patient outcomes. We retrospectively analyzed 30- and 90-day readmission rates and indications in patients who underwent liver transplant at a large-volume transplant center over a 3-year period. Four hundred seventy-nine adult patients underwent their first liver transplant during the study period. The 30-day readmission rate was 29.6%. Recipient and donor age, etiology of liver disease, biological Model for End-Stage Liver Disease score, and cold ischemia time were similar between patients who were readmitted within 30 days and those who were not readmitted. Readmissions occurred in 25% of patients who were hospitalized prior to liver transplant compared to 30% who were admitted for liver transplant. The most common indications for readmission were infection, severe abdominal pain, and biliary complications. Early discharge from hospital (fewer than 7 days after liver transplant), was not associated with readmission; however, a prolonged hospital stay after liver transplant was associated with an increased risk of readmission (p = 0.04). In conclusion, patients who undergo liver transplant have a high rate of readmission. In our cohort, readmissions were unrelated to pre-existing recipient or donor factors, but were associated with a longer hospital stay after liver transplant.