Pre-discharge factors associated with unplanned readmission of patients with home mechanical ventilation: a retrospective study

Abstract

Background: Higher prevalence rate of patients with prolonged mechanical ventilation, among them have ventilated at home. However, unplanned hospital readmission of home ventilated patients remains a critical issue. Therefore, to explore the characteristics and prognosis of unplanned readmissions of patients using a home ventilator and to analyze relevant pre-discharge factors that affect such unplanned readmissions.Methods: A retrospective study was conducted to collect medical record data for 2013–2017 on the readmission of home-ventilated patients in a medical center in northern Taiwan. In all, 127 cases were considered. Unplanned readmissions were divided by time intervals (≤ 30 days, 31–180 days, 181–365 days, ≥ 366 days) into an early readmission group (≤ 30 days) and a late readmission group (≥ 31 days). Statistical analysis, a chi-square test, and a multivariate logistic regression analysis model were used to verify the factors influencing the readmission of home-ventilated patients.Results: Patients’ populations according to the intervals of unplanned readmission (≤ 30 days, 31–180 days, 181–365 days, ≥ 366 days) were 42 (33.1%), 60 (47.2%), 17 (13.4%), and 8 (6.3%), respectively. The average intervals of home care for the early readmission group (≤ 30 days) and the late readmission group (≥ 31 days) were 15.1 ± 9.2 and 164.8 ± 143.2 days, respectively. Regarding risk factors of early and late unplanned hospital readmission, the odds ratio (OR) for patients with chronic cardiovascular disease compared with those without this disease was 4.535 (95% CI 1.253 -16.413). For maximum inspiratory pressure ≦ −30 cmH2O compared with > −30 cmH2O, the OR for early readmission was 0.207 (95% CI 0.056 - 0.767). For hemoglobin ≥ 10.1 g/dL compared with < 10.1 g/dL, the OR of early readmission was 0.280 (95% CI 0.082 - 0.958).Conclusion: Pre-discharge problems, including chronic cardiovascular disease, maximum inspiratory pressure, and reduced hemoglobin, are risk factors for unplanned early hospitalization readmission of patients using a ventilator at home. Therefore, attention should be paid to these risk factors during discharge planning.