Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study

Abstract

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is a practical and effective way of delivering antimicrobial therapy, but may be associated with significant risk for hospital readmission. This study aimed to elucidate risk factors related to 30-day readmissions in patients who were discharged with OPAT at Mount Sinai Beth Israel (MSBI).MethodsThis IRB approved retrospective cohort study included patients who were at least 18 years or older, admitted to MSBI from August 2015 to March 2016, and discharged to receive OPAT. Patients with intravenous antibiotics prescribed for chronic suppression or planned readmission within 30 days were excluded. The main outcome was readmission to the hospital within 30 days from previous hospital discharge. Univariate and logistic regression analyses were performed to determine predictors of 30-day readmission.ResultsThere were a total of 200 patients included in the analysis; the median age was 60 years, 65.5% were male, and the median Charlson score was 2. A total of 155 (78%) patients received a peripherally inserted central catheter (PICC); the remainder was discharged with a midline. The most common medications prescribed for OPAT included cephalosporins (41%), vancomycin (31%), carbapenems (23%), and penicillins (16%). A total of 42 patients (21%) were readmitted within 30 days after previous discharge. Discharge to a skilled nursing facility or subacute rehabilitation center was found to be an independent predictor of readmission on logistic regression analyses (p < 0.05).ConclusionReadmissions are common in patients discharged with OPAT. Recognizing predictors of readmission may help determine strategies to optimize care.

Risk Factors For Readmission Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy; A Retrospective Cohort Study

“…This is the rst study to identify infected prosthetic material as an independent predictor of readmission in OPAT-patients. A different study found discharge to a skilled nursing facility to be associated with a higher risk of readmission [7]. We were not able to con rm this nding in this study.…”

“…Although consultation of the OPAT-team has been proposed for every patient before the initiation of OPAT, identifying patients with a high risk for readmission remains di cult. Previous studies have identi ed various risk factors to be associated with readmission, such as; discharge to a skilled nursing facility [7], previous hospital admission [9] and discharge with medication subject to TDM [6,16]. The aim of this study is to identify risk factors associated with readmission in patients receiving OPAT, in a hospital without a dedicated OPAT-team.…”

Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study

“…Previous studies have also described a high satisfaction rate of patients treated with OPAT at home [4,5]. Although OPAT is usually considered safe, people receiving antimicrobials at home remain at risk for adverse events and readmission and therefore require appropriate follow-up and laboratory monitoring in the outpatient setting, when discharged with OPAT [6][7][8][9].…”

Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety

“…Secure and reliable venous access is a cornerstone in the care of hospitalized and critically ill patients [1]. As care transitions occur with greater frequency, the need for safe access to also continue in the ambulatory setting has been increasingly recognized [2]. As such, the demand and market for devices that provide reliable and prolonged venous access has always been strong.…”