Readmission of older acutely admitted medical patients after short-term admissions in Denmark: a nationwide cohort study

Abstract

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 (

Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study

“…However, the mortality rates are not negligible, and it is noticeable that patients with pneumonia had a shorter time to death. In a previous study [ 8 ] from our group it was shown that older patients with pneumonia and urinary tract infections had an increased risk of readmission in the 30-day period after discharge. We do not have data on the causes of readmission and death, however, the present results indicate a need for increased focus on patients with these infectious diseases during discharge planning, to optimize treatment and out of hospital care to reduce the risk of complications after discharge.…”

“…Male gender had in our study a 22% increased risk of death compared to females. Male gender has been associated with many negative health outcomes in older age, including earlier onset of chronic diseases, more readmissions and shorter survival at nursing homes [ 1 , 8 , 19 , 20 ]. Worldwide, men do have shorter lifespan and higher rates of lethal conditions as heart disease and stroke than women, partly due to behavioral differences [ 21 ].…”

“…The number of comorbid conditions was a prognostic factor in our study, as in earlier research with a positive gradient among the number of diseases and mortality [ 27 ]: We found a mortality rate of 1.3% in patients with CCI 0, increasing to over 5% in patients with CCI 3+. Previously, we have found an association between CCI and readmission [ 8 ]. These findings indicate a need to take chronic disorders into consideration during discharge planning, both concerning medical treatment, follow-up and care.…”

“…The methods used to identify patients and to collect data have previously been described in a study of readmission of older patients after early discharge [ 8 ].…”

“…Old people are vulnerable having a burden of comorbidities and multiple medications, and do often need help doing everyday activities because of a reduced functional capacity [ 1 , 7 ]. We have previously published a 30-day mortality rate of 3 % among elderly acutely admitted medical patients who were discharged within 24 h [ 8 ]. However, more research on the safety of early discharge and predictors of adverse events after discharge of older patients is needed [ 9 ].…”