Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study

Q: What are the key findings of this study?

In patients with severe obesity, higher BMI was significantly associated with an increased risk of long-term hospital readmission (HR 1.02 per unit, p=0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe obesity (n=1136). Intervention: Higher Body Mass Index (BMI) vs. Lower BMI (evaluated as a continuous predictor per unit). Primary outcome: Long-term hospital readmission (HR 1.02, 95% CI 1.01-1.03, p=0.001).

Fabio Bioletto; Andrea Evangelista; Giovannino Ciccone; Amelia Brunani; Valentina Ponzo; Enrica Migliore; Eva Pagano; Isabella Comazzi; Fabio Dario Merlo; Farnaz Rahimi; Ezio Ghigo; Simona Bo

doi:10.3390/nu15163648

August 20, 2023NutrientsOpen Access

Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study

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Key result

Higher BMI linked to ~2% higher long-term readmission risk per unit in severe obesity.

HR 1.02
95% CI 1.01-1.03
P=0.001
n=1,136

Figures

Why the study?

Adults with obesity face higher hospitalization risks and healthcare costs, but a predictive model for hospital readmission in patients with severe obesity is lacking.

What are the predictive variables associated with early and long-term hospital readmission in patients with severe obesity?

Key Points

To identify clinical predictors of 30-day, 90-day, and long-term hospital readmissions in patients hospitalized for severe obesity.
Retrospective cohort study of 1136 patients admitted for severe obesity (BMI ≥ 40 kg/m2) between 2009 and 2018 at Istituto Auxologico Italiano in Piancavallo.
Tracked readmissions through regional deterministic record linkage over a median follow-up of 5.7 years (IQR: 3.1–8.2), evaluating 2066 total subsequent hospitalizations.
Long-term readmission was predicted by age (HR = 1.02 per year, 95%CI: 1.01–1.03, p < 0.001), BMI (HR = 1.02 per unit, 95%CI: 1.01–1.03, p = 0.001), smoking (HR = 1.17, 95%CI: 0.99–1.38, p = 0.060), serum creatinine (HR = 1.22 per unit, 95%CI: 1.04–1.44, p = 0.016), type 2 diabetes mellitus (HR = 1.17, 95%CI: 1.00–1.36, p = 0.045), and prior 2-year admissions (HR = 1.15 per unit, 95%CI: 1.07–1.23, p < 0.001).
Of all readmissions, 194 (9.4%) occurred within 30 days and 444 (21.5%) within 90 days; BMI lost predictive significance for readmissions within 90 days, while both BMI and diabetes lost predictive significance within 30 days.
Model discrimination demonstrated an area under the curve starting at approximately 0.7 immediately post-discharge, declining to 0.6 across 30 days and remaining at roughly 0.6 up to 2 years.

Study Design

Type

Cohort (n=1,136)

Multicenter

No

Structured PICO

What are the predictive variables associated with early and long-term hospital readmission in patients with severe obesity?

P

Population

1,136 adults with severe obesity (mean BMI 47.4 kg/m2, 62.3% female), free of prior bariatric surgery, followed for a median of 5.7 years.

E

Exposure

Risk factors including increasing age, BMI, smoking habit, elevated serum creatinine, type 2 diabetes mellitus, and number of previous hospital admissions.

O

Outcome

Hospital readmission evaluated at 30 days, 90 days, and without time restrictions (long-term)hard clinical

Main Result

Hazard Ratio: 1.02 (95% CI 1.01–1.03)

p-value: p=0.001

Clinical and demographic factors including age, BMI, diabetes, and recent hospital admissions can independently predict the risk of early and long-term readmission in patients with severe obesity.

Limitations

Residual or unmeasured confounding variables
Anthropometric and biochemical assessments were performed only at the time of enrolment
Cohort consisted of patients admitted to a single specialized tertiary care center, which may limit generalizability
Cohort from a specialized tertiary care center might not be fully representative of the overall population of patients with severe obesity

Implication

Higher BMI may flag long-term readmission risk in severe obesity; leaves open whether weight reduction alters outcomes.

Abstract

Adults with obesity have a higher risk of hospitalization and high hospitalization-related healthcare costs. However, a predictive model for the risk of readmission in patients with severe obesity is lacking. We conducted a retrospective cohort study enrolling all patients admitted for severe obesity (BMI ≥ 40 kg/m2) between 2009 and 2018 to the Istituto Auxologico Italiano in Piancavallo. For each patient, all subsequent hospitalizations were identified from the regional database by a deterministic record-linkage procedure. A total of 1136 patients were enrolled and followed up for a median of 5.7 years (IQR: 3.1–8.2). The predictive factors associated with hospital readmission were age (HR = 1.02, 95%CI: 1.01–1.03, p < 0.001), BMI (HR = 1.02, 95%CI: 1.01–1.03, p = 0.001), smoking habit (HR = 1.17, 95%CI: 0.99–1.38, p = 0.060), serum creatinine (HR = 1.22, 95%CI: 1.04–1.44, p = 0.016), diabetes (HR = 1.17, 95%CI: 1.00–1.36, p = 0.045), and number of admissions in the previous two years (HR = 1.15, 95%CI: 1.07–1.23, p < 0.001). BMI lost its predictive role when restricting the analysis to readmissions within 90 days. BMI and diabetes lost their predictive roles when further restricting the analysis to readmissions within 30 days. In conclusion, in this study, we identified predictive variables associated with early and long-term hospital readmission in patients with severe obesity. Whether addressing modifiable risk factors could improve the outcome remains to be established.

Discussion

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Cite This Study

Bioletto et al. (2023) conducted a cohort in Severe obesity (n=1,136). Higher Body Mass Index (BMI) vs. Lower BMI (evaluated as a continuous predictor per unit) was evaluated on Long-term hospital readmission (HR 1.02, 95% CI 1.01-1.03, p=0.001). In patients with severe obesity, higher BMI was significantly associated with an increased risk of long-term hospital readmission (HR 1.02 per unit, p=0.001).

synapsesocial.com/papers/6a20d030fd936e2c9649c4a2 https://doi.org/10.3390/nu15163648

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Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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