Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

Abstract

ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

Machine Learning Models for Predicting 30-Day Readmission of Elderly Patients Using Custom Target Encoding Approach

“…In concordance with previous studies, the number of comorbidities directly correlates with the frequency of 30-day readmission after hospital discharge [20] [21]. Particularly such conditions as fluid and electrolyte disorders, cardiac arrhythmia, hypertension, congestive heart failure, pulmonary circulation disorders, depression, and malignant cancer.…”

Telehealth Use and Hospital Readmission Rates in Long-term Care Facilities in Southeastern Minnesota During the COVID-19 Pandemic

“…Our findings are also consistent with those of multiple studies that have identified polypharmacy as a risk factor for hospitalization, longer length of hospital stay, and mortality risk in older patients. [22][23][24] The lower readmission rate of 10.2% overall likely reflects the dramatic change in hospitalization and rehospitalization during the COVID-19 pandemic. The patterns of hospital readmission changed after COVID-19 became an important cause of hospitalization.…”

Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives

“…Without preventative measures, MRPs can lead to physical and cognitive decline, exacerbated chronic medical conditions, rehospitalisations, avoidable health costs [9][10][11], and, sometimes, unplanned institutionalisation [12]. Nurses can play a crucial preventative role in ensuring safe medication management for polymedicated home-dwelling older adults [13,14].…”