Key result
Among older acutely admitted medical patients discharged within 24 hours, 20.3% were readmitted within 30 days, with a Charlson Comorbidity Index ≥3 significantly increasing the risk (aHR 2.28).
Why the study?
Knowledge of unplanned readmission rates and prognostic factors for readmission among older people after early discharge from emergency departments was sparse.
Cohort (n=93,306)
Yes
One fifth of acutely admitted medical patients aged ≥65 are readmitted within 30 days after early discharge, with male gender and higher comorbidity burden being significant risk factors.
Answers are grounded in this paper and cite their sources.
May inform risk stratification after short admissions in older patients; leaves open whether targeting identified factors reduces readmissions.
BACKGROUND: Knowledge of unplanned readmission rates and prognostic factors for readmission among older people after early discharge from emergency departments is sparse. The aims of this study were to examine the unplanned readmission rate among older patients after short-term admission, and to examine risk factors for readmission including demographic factors, comorbidity and admission diagnoses. METHODS: This cohort study included all medical patients aged ≥65 years acutely admitted to Danish hospitals between 1 January 2013 and 30 June 2014 and surviving a hospital stay of ≤24 h. Data on readmission within 30 days, comorbidity, demographic factors, discharge diagnoses and mortality were obtained from the Danish National Registry of Patients and the Danish Civil Registration System. We examined risk factors for readmission using a multivariable Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for readmission. RESULTS: A total of 93,306 patients with a median age of 75 years were acutely admitted and discharged within 24 h, and 18,958 (20.3%; 95% CI 20.1 - 20.6%) were readmitted with a median time to readmission of 8 days (IQR 3 - 16 days). The majority were readmitted with a new diagnosis. Male sex (aHR 1.15; 1.11 - 1.18) and a Charlson Comorbidity Index ≥3 (aHR 2.28; 2.20 - 2.37) were associated with an increased risk of readmission. Discharge diagnoses associated with increased risk of readmission were heart failure (aHR 1.26; 1.12 - 1.41), chronic obstructive pulmonary disease (aHR 1.33; 1.25 - 1.43), dehydration (aHR 1.28; 1.17 - 1.39), constipation (aHR 1.26; 1.14 - 1.39), anemia (aHR 1.45; 1.38 - 1.54), pneumonia (aHR 1.15; 1.06 - 1.25), urinary tract infection (aHR 1.15; 1.07 - 1.24), suspicion of malignancy (aHR 1.51; 1.37 - 1.66), fever (aHR 1.52; 1.33 - 1.73) and abdominal pain (aHR 1.12; 1.05 - 1.19). CONCLUSIONS: One fifth of acutely admitted medical patients aged ≥65 were readmitted within 30 days after early discharge. Male gender, the burden of comorbidity and several primary discharge diagnoses were risk factors for readmission.
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Klinge et al. (2020) conducted a cohort in Acute medical admission (n=93,306). Charlson Comorbidity Index ≥3 vs. Charlson Comorbidity Index 0 was evaluated on Acute medical readmission within 30 days of discharge (aHR 2.28, 95% CI 2.20-2.37). Among older acutely admitted medical patients discharged within 24 hours, 20.3% were readmitted within 30 days, with a Charlson Comorbidity Index ≥3 significantly increasing the risk (aHR 2.28).
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