Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study

Abstract

ObjectivesLimited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.DesignA retrospective cohort study.SettingTwo tertiary-level hospitals in Australia.ParticipantsAll medical admissions ≥18 years over a period of 1 year.OutcomesPrimary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.ResultsThere were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.ConclusionsMalnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.Trial registrationANZCTRN 12617001362381; Results.

The Association between Oral Nutritional Supplements and 30-Day Hospital Readmissions of Malnourished Patients at a US Academic Medical Center

“…Although the retrospective study design employed is only able to imply correlations between the assessed factors, the current findings are consistent with previous studies showing that ONS use, with or without other nutrition interventions, can reduce readmissions of nutritionally vulnerable inpatient populations, including oncology patients. 9,17,20,31,32 The results also suggest an association between time to ONS ordering from hospital admission and hospital LOS; shorter intervals to ordering ONS were associated with shorter LOS. Furthermore, a 50% reduction in the time to ONS order was associated with a 10.2% decrease in overall LOS, including 10.2% and 16.2% decreases for patients in the oncology and ICU departments, respectively, who had confirmed malnutrition.…”

The Association between Nutritional Status and In-Hospital Mortality among Patients with Acute Coronary Syndrome—A Result of the Retrospective Nutritional Status Heart Study (NSHS)

“…At the same time, malnutrition is associated with a longer stay at a medical facility, increased number of hospitalizations, rehospitalization, the risk of treatment-related complications and even an increased risk of mortality. Therefore, it is a public health problem, as it increases the costs of the patient’s treatments [ 11 , 12 , 13 ]. The state of malnutrition among patients with AMI affects the number of complications and treatment outcomes [ 14 ].…”

Self‐Completion of the Patient‐Generated Subjective Global Assessment Short Form Is Feasible and Is Associated With Increased Awareness on Malnutrition Risk in Patients With Head and Neck Cancer

“…[3][4][5] At diagnosis, nearly 20% of patients with head and neck cancer are estimated to be at risk, 4 and shortly after cancer treatment, prevalence may be increased to about 50%. 5 Malnutrition and malnutrition risk are associated with poorer outcomes, such as increased length of hospital stay, 6,7 increased number of readmissions, 8 lower quality of life, decreased survival, 7 and increased healthcare costs. 7,9,10 Hence, nutrition screening is an important component of the nutrition care process.…”