Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital

Abstract

Frequent emergency readmissions, an indicator of quality of care, has been rising in England but the underlying reasons remain unclear. We examined the association of early readmissions with subsequent mortality in adults, taking into account the underlying presenting diagnoses and hospital length of stay (LOS). Data of alive-discharge episodes were prospectively collected between 01/04/2017 and 31/03/2019 in an National Health Service hospital, comprising 32,270 patients (46.1% men) aged 18–107 years (mean = 64.0, ± SD = 20.5 years). The associations of readmission frequency within 28 days of discharge and mortality within 30 days and 6 months of hospital discharge, and over a 2-year period were evaluated, adjusted for presenting diagnoses, LOS, age and sex during the first admission. Analysis of all patients 18–107 years (reference: no readmission) showed mortality within 30 days was increased for 1 readmission: event rate = 9.2%, odds ratio (OR) = 3.4 (95% confidence interval (CI) = 2.9–4.0), and ≥ 2 readmissions: event rate = 10.0%, OR = 2.6 (95%CI = 2.0–3.3), and within 6 months for 1 readmission: event rate = 19.6%, OR = 3.0 (95%CI = 2.7–3.4), and ≥ 2 readmissions: event rate = 27.4%, OR = 3.4 (95%CI = 2.9–4.0), and over a 2-year period for 1 readmission: event rate = 25.5%, hazard ratio = 2.2 (95%CI = 2.0–2.4), and ≥ 2 readmissions: event rate = 36.1%, hazard ratio = 2.5 (95%CI = 2.2–2.8). Within the age groups 18–49, 50–59, 60–69, 70–79 and ≥ 80 years, readmissions were also associated with increased risk of mortality within 3 months and 6 months of discharge, and over 2-year period. In conclusion, early hospital readmission predicts short-, medium- and long-term mortality post-discharge from hospital in adults aged 18–107 years, independent of underlying presenting conditions, LOS, age and sex. Further research focussing on safe discharge and follow-up patient care may help reduce preventable readmissions and post-discharge mortality.

Frequent users of health services among community‐based older Australians: Characteristics and association with mortality

“…We found that being a frequent user was significantly associated with an increased risk of mortality with frequent users of EDs having a 95% increased mortality followed by frequent users of hospitals (67% higher), frequent users of GPs (50% higher) and frequent users of medical specialists (44% higher). Our mortality risk results were slightly lower than other studies investigating outcomes of frequent users of EDs and hospitals on mortality rates, although many of these studies are not community‐based 25,26 . A systematic review by Moe et al, which summarised evidence from 31 studies, found that frequent users of EDs are at increased odds of death of around 2.2 25 .…”

“…There were also some factors that were less likely to be associated with frequent users across services, such as adequate physical activity, reporting good quality of life and consuming 1–13 alcoholic drinks per week. Reporting poorer or lower quality of life was supported by evidence that frequent users of medical specialists, EDs and hospitalisations were more likely to report poorer health 13,14,26 . With regard to consuming 1–13 alcoholic drinks per week, there is growing evidence that low to moderate alcohol consumption is protective as people age, 24 although it is not clear if the benefit is because of the ethanol or the social and pleasurable benefits of drinking alcohol.…”

“…Our mortality risk results were slightly lower than other studies investigating outcomes of frequent users of EDs and hospitals on mortality rates, although many of these studies are not community‐based. 25 , 26 A systematic review by Moe et al, which summarised evidence from 31 studies, found that frequent users of EDs are at increased odds of death of around 2.2. 25 We are not aware of any studies investigating the impact of frequent users (GPs or medical specialists) on mortality.…”

MAIT cell counts are associated with the risk of hospitalization in COPD

“…We aimed to investigate if MAIT cells may be associated with COPD morbidity. As a measure of morbidity, we chose all-cause hospitalization during the 3-year follow-up because it is a strictly objective outcome that is easily measured, associated with considerable healthcare costs and strongly linked to mortality [ 29 ].…”

"A Retrospective Study of Insulin Resistance in Discharged and Deceased Patients"

“…Moreover, the age and gender information of the discharged and deceased patients were also recorded with HİIMS. Because as seen in hospital discharge and mortality studies, age, gender, and frequency of admission were taken into account (Heppleston E,et al [6,7]). In this respect, our study is compatible with the literature.…”