Short-term hospitalisation and early readmission of older patients: A case-control study

Background Pressure on health care capacity pushes for shorter hospital stays with early discharge from Emergency Departments (ED), leading to a vicious discharge-readmissions circle toxic to the rising number of older patients. Thus, risk factors for early readmission following short-term ED-stays of older patients needs attention. Methods This case-control study scrutinised hospital records and the prescription database for data on demography, marital status, disability, Charlson comorbidity index (CCI), and redeemed systemic prescription drugs. Patients included were aged ≥70 years, had a primary hospitalisation with discharge from the ED <48 hours, and were readmitted within 7 or 30 days. Exclusion criteria were readmission for specialised treatment and multi-trauma. Data covered hospitalisations for 12-months, and the setting was publicly funded health care. Results Among 2,343 patients aged ≥70 years with short-term hospitalisation, 266 (11.4%) were readmitted within 30 days, nearly half within 7 days, and one in three with similar diagnosis. Fifty patients were excluded leading to comparison with 432 cases and matched controls. Polypharmacy (≥8 drugs), CCI, marital status, and disability differed markedly with odds ratios for early readmission of 4.3 (95%-CI: 1.4-17, polypharmacy); 2.0 (95%-CI: 1.3-3.0, CCI ≥2); 1.8 (95%-CI: 1.1-2.8, unwed status); 1.6 (95%-CI: 1.0-2.5, disability). Conclusion Four major risk factors for early readmission of older patients discharged from the ED within 48 hours were identified and relevant as one in three had similar diagnosis at discharge and readmission. These findings should guide the ED attending physician’s focus to prevent early readmission.