Impact of medication intensification on 30‐day hospital readmissions in a geriatric trauma population: A multicenter cohort study

Abstract

BackgroundFall‐related injuries are a significant health issue that occur in 25% of older adults and account for a significant number of trauma‐related hospitalizations. Although medication intensification may increase the risk of hospital readmissions in non‐trauma patients, data on a geriatric trauma population are lacking.ObjectiveThe primary objective was to evaluate the effect of medication intensification on 30‐day hospital readmissions in geriatric patients hospitalized for fall‐related injuries.MethodsThis multicenter, retrospective cohort study included patients with geriatric who presented to one of three trauma centers within a large, health‐system between January 1, 2018 and December 31, 2020. Patients at least 65 years old admitted with a fall‐related injury were eligible for inclusion. Patients were grouped according to medication changes at discharge, which included intensified and non‐intensified groups. Medication intensification included increased dose(s) or initiation of new agents. The primary outcome was the 30‐day hospital readmission rate.ResultsOf the 870 patients included (median [interquartile range, IQR] age, 82 [74–89] years, 522 (60%) female, and 220 (25%) with a previous fall), there were 471 (54%) and 399 (46%) patients in the intensified and non‐intensified groups, respectively. The intensified group had a higher 30‐day hospital readmission rate (21% intensified vs. 16% non‐intensified, p = 0.043; number needed to harm 20) based on an unweighted analysis. According to a weighted propensity score logistic regression, medication intensification was associated with higher 30‐day hospital readmissions (24% [95% confidence interval [CI] 19–31%] intensified vs. 15% [95% CI 11–20%] non‐intensified, p = 0.018). These results were consistent within competing risk models accounting for death (cause‐specific model: hazard ratio [HR] 1.63 [95% CI 1.07–2.49], p = 0.023; Fine‐Gray model: HR 1.64 [95% CI 1.07–2.50], p = 0.022).ConclusionsIn a geriatric trauma population hospitalized after a fall, intensification of medications may pose an increased risk of 30‐day hospital readmission.