Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions

Abstract

ObjectiveHospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP.DesignA cross-sectional study.SettingThe study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013–2014 and 2014–2015).ParticipantsWe included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted.Main outcome measures30-day readmission.ResultsFactors associated with 30-day readmission were living with a person aged <15 years (adjusted OR (aOR) 2.10, 95% CI 1.01 to 4.41), >3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons.ConclusionsThis study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factors.

Risk factors of 90-day rehospitalization following discharge of pediatric patients hospitalized with mycoplasma Pneumoniae pneumonia

“…In terms of safety and cost, it is important to assess the relationship between initial hospital stay and readmission outcomes [9, 20]. Although the investigation of risk factors is challenging, significant progress has been made on the elderly, that the readmission was found to be largely depends on the comorbidities and factors external to the patient [1, 2, 4, 21]. This has also been observed in children, and one of the identified risk factors is chronic medical conditions such as underlying pulmonary or cardiovascular disease [9–11].…”

Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age

“…Adult survivors of CAP are at increased risk of death for up to 10 years following recovery, and CAP survivorship is associated with poorer life satisfaction, increased healthcare expenditure, need for domiciliary care, frailty5 and high readmission rates 6. Eleven per cent of older adults are readmitted within 30 days, often for a secondary infection 6. These secondary infections are associated with increased length of stay, mortality and further readmissions 6…”

“…Eleven per cent of older adults are readmitted within 30 days, often for a secondary infection 6. These secondary infections are associated with increased length of stay, mortality and further readmissions 6…”

Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

“…Great efforts have been put on identification of risk factors for readmission following hospitalization for pneumonia. Comorbidities, socioeconomic status, and so on play a pivotal role in this regard [ 27 , 28 ]; however, to our knowledge, none of the studies identified the association between GI dysfunction during the index hospitalization and risks of readmission. Our finding may not be that unexpected but is pathophysiologically plausible.…”