Key result
Potentially inappropriate discharge medications are not linked to 30-day readmissions or emergency department visits.
Why the study?
To evaluate the independent effect of potentially inappropriate medications on 30-day post-discharge outcomes in hospitalized older adults after controlling for polypharmacy and psychological comorbidities, and identify high-risk phenotypes.
Does potentially inappropriate medication use increase the risk of 30-day unplanned readmission or ED visits in hospitalized older adults?
Cohort (n=1,264)
No
Does potentially inappropriate medication use increase the risk of 30-day unplanned readmission or ED visits in hospitalized older adults?
Hazard Ratio: 1.22 (95% CI 0.92–1.62)
Absolute Event Rate: 20% vs 16.2%
p-value: p=0.16
While overall potentially inappropriate medication use is not an independent predictor of 30-day readmission or ED visits after adjusting for polypharmacy, it significantly increases risk in patients with reduced physiologic reserve and those with inappropriate proton pump inhibitor use.
Does not support changing discharge medication review; leaves open targeted PIM effects in critically ill subgroups.
Objectives To investigate the independent effect of potentially inappropriate medications (PIMs) on 30-day adverse post-discharge outcomes (unplanned readmissions or emergency department [ED] visits) among hospitalized older adults after strictly controlling for confounders, such as polypharmacy and psychological comorbidities, and to identify high-risk phenotype in patients with reduced physiologic reserve and specific drug classes associated with adverse outcomes. Methods This retrospective cohort study included 1,264 older patients (aged ≥65 years). PIMs were identified at discharge. Multivariable Cox regression and 1:1 propensity score matching (PSM, caliper 0.02) were used to adjust for confounders, including medication count and psychological comorbidities. Sensitivity, subgroup, drug-specific, and E-value analyses were performed to assess risk heterogeneity and robustness. Results Overall, 41.8% of the patients (n = 529) were exposed to PIMs. PIM status was not significantly associated with the 30-day composite outcome (unplanned readmission or ED visits) in either the total population (n = 1,264; adjusted hazard ratio [AHR] 1.22, 95% confidence interval [CI] 0.92–1.62, P = 0.16) or the PSM cohort (n = 776; AHR 1.12, 95% CI 0.81–1.54, P = 0.49). However, subgroup analysis revealed significant risk elevation in critically ill patients (AHR 1.84, 95% CI 1.14–2.99), although the interaction was not statistically significant ( P = 0.07). Additionally, inappropriate proton pump inhibitor (PPI) use was associated with increased risk (AHR 1.39, 95% CI 1.02–1.89). Conclusion After controlling for polypharmacy, PIM was not a uniform predictor of the 30-day composite outcome, but it served as a marker of clinical complexity. However, it became a significant marker of risk in patients with reduced physiologic reserve and in those with inappropriate PPI use. Clinical interventions should prioritize these high-risk phenotypes for precision deprescribing.
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Zeng et al. (2026) conducted a cohort in Hospitalized older adults (n=1,264). Potentially inappropriate medications (PIMs) vs. No potentially inappropriate medications was evaluated on 30-day composite outcome of unplanned hospital readmission or emergency department visit (AHR 1.22, 95% CI 0.92-1.62, p=0.16). Potentially inappropriate medication use at discharge was not significantly associated with a 30-day composite outcome of unplanned readmission or emergency department visits (AHR 1.22).
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