To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. Design: Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged !75 years. Setting: Acute care hospitals. Participants: Patients who underwent rehabilitation and were discharged to home (NZ31,247; mean age in years AE SD, 84.1AE5.7) between October 2013 and July 2014. Interventions: None. Main Outcome Measure: 30-day PAR. Results: Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<.001), and the odds of 30-day PAR among patients with a higher number (median or higher) of rehabilitation units were 2.031 times higher than those of patients with a lower number (below median) (P<.001). Also, the odds of 30-day PAR among patients with a higher Hospital Frailty Risk Score (median or higher) were 1.252 times higher than those of patients with a lower score (below median) (PZ.001). Conclusions: The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.

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Objective: To examine the association of BMI with mortality and related outcomes after oncologic esophagectomy. Summary Background Data: Previous studies showed that high BMI was a risk factor for anastomotic leakage and low BMI was a risk factor for respiratory complications after esophagectomy. However, the association between BMI and in-hospital mortality after oncologic esophagectomy remains unclear. Methods: Data for patients who underwent esophagectomy for esophageal cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Multivariate regression analyses and restricted cubic spline analyses were used to investigate the associations between BMI and short-term outcomes, adjusting for potential confounders. Results: Among 39,406 eligible patients, in-hospital mortality, major complications, and multiple complications (≥2 major complications) occurred in 1069 (2.7%), 14,824 (37.6%), and 3621 (9.2%), respectively. Compared with normal weight (18.5–22.9 kg/m2), severe underweight (<16.0 kg/m2), mild/moderate underweight (16.0–18.4 kg/m2), and obese (≥27.5 kg/m2)were significantly associated with higher in-hospital mortality [odds ratio 2.20 (95% confidence interval 1.65–2.94), 1.25 (1.01–1.49), and 1.48 (1.05–2.09), respectively]. BMI showed U-shaped dose-response associations with mortality, major complications, and multiple complications. BMI also showed a reverse J-shaped association with failure to rescue (death after major complications). Conclusions: Both high BMI and low BMI were associated with mortality, major complications and multiple complications after esophagectomy for esophageal cancer. Patients with low BMI were more likely to die once a major complication occurred. The present results can assist with risk stratification in patients undergoing oncologic esophagectomy.

Objective: To examine whether the issue and dissemination of national guidelines in the Manual of Antimicrobial Stewardship had an impact on reducing antibiotic use for acute respiratory tract infection (ARTI) and gastroenteritis. Method: An interrupted time-series analysis was performed using a large nationwide database from June 2016 to June 2018. Outpatients with ARTI or gastroenteritis aged ≥6 years were identified. The outcome measures were any antibiotic use and broad-spectrum antibiotic use. The season-adjusted changes in the rate of antibiotic prescriptions for 2 periods before and after the guideline issue date were examined. Results: There were 13,177,735 patients with ARTI and 300,565 patients with gastroenteritis during the study period. Among patients with ARTI, there was a significant downward trend in antibiotic use during the 2-year study period (−0.06% per week; 95% CI, −0.07% to −0.04%). However, there was no significant change in trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.01% per week; 95% CI, −0.10% to 0.07%). Similarly, for patients with gastroenteritis, there was no significant change in the trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.02% per week; 95% CI, −0.04% to 0.01%). Similar associations were observed in analyses for broad-spectrum antibiotic use. Conclusions: Despite the issue of national guidelines to promote the appropriate use of antibiotics, there were no significant changes in trends of antibiotic use for outpatients with ARTI or gastroenteritis between the pre-issue and post-issue periods.

a BStra ct BacKgrOUnD It is unknown which medical diagnoses are strongly associated with long-term care needs certification. MetHODSWe conducted a case-control study using linked medical and long-term care data from two Japanese cities. The participants were aged ≥75 years, without any previous long-term care needs certification, and had at least one medical insurance claim record during a period between April 2013 and March 2015 in City A and between April 2013 and November 2016 in City B. Cases were newly certified people for long-term care needs during the study period, whereas controls (matched on age category, sex, city, and calendar date) were randomly selected in a 1:4 ratio. We conducted multivariable conditional logistic regression analyses to estimate the association between 22 categories of medical diagnoses recorded in the past six months and new (i.e., first ever) long-term care needs certification. reSUltS Among 38,338 eligible people, 5,434 (14.2%) newly received long-term care needs certification. The adjusted odds ratio (95% confidence interval) was largest for femur fractures, 8.80 (6.35-12.20), followed by dementia, 6.70 (5.96-7.53), pneumonia, 3.72 (3.19-4.32), hemorrhagic stroke, 3.31 (2.53-4.34), Parkinson's disease, 2.74 (2.07-3.63), and other fractures, 2.68 (2.38-3.02). A restricted analysis to more severe outcome (care need levels 2 to 5), sensitivity analysis to use different periods for exposure definition, and separate analysis by city showed consistent results. cOnclUSiOnS Among a range of recorded medical diagnoses, fractures (especially femur fractures), dementia, pneumonia, hemorrhagic stroke, and Parkinson's disease were strongly associated with long-term care needs certification.