De Giorgi A, Boari B, Tiseo R, López-Soto P J, Signani F, Gallerani M, Manfredini R, Fabbian F
School of Medicine, University of Ferrara, Ferrara, Italy.
Eur Rev Med Pharmacol Sci. 2016 Nov;20(21):4557-4564.
Readmissions to hospital after discharge are considered adverse, serious and costly outcomes. In the last years, two new scores have been proposed to identify patients at high risk of hospital readmission, the HOSPITAL and the Elders Risk Assessment (ERA) indexes. The aim of this study was to evaluate these two scores and the risk of death among internal medicine readmitted patients.
During a 30-month period, we identified 613 readmitted patients out of 13,237 admissions. Age, sex, length-of-hospital stay (LOS), and deaths were retrospectively analyzed. Readmissions with diagnosis coincident with the index hospitalization were classified as avoidable, whilst those with a different diagnosis were defined as non-avoidable. HOSPITAL score for 30-day potentially avoidable readmission and ERA indexes were calculated.
Readmitted patients (56.6% women), were aged 79±10.4 years. The incidence of 30-day readmission was 20.4 patients/month. Re-hospitalization could be classified as avoidable in 286 cases (46.7%), and death at the end of follow-up was recorded in 366 (59.7%). HOSPITAL score ≥ 7 and ERA score ≥ 16, both able to identify high risk patients for readmission, were present in 108 (17.6%) and 385 (64.4%) of cases, respectively. Patients with non-avoidable readmissions were older, more frequently female, diabetic, and had higher ERA score than subjects with avoidable readmission. Multivariate logistic regression analysis showed that non-avoidable readmissions were independently associated with female gender (OR 1.410 [95% CI 1.012-1.964], p=0.042), and age (OR 1.025 [95% CI 1.006-1.043], p=0.01), while only age (OR 1.034 [95% CI 1.015-1.054], p<0.001) and ERA score (OR 1.047 [95% CI 1.001-1.095], p=0.047) were independently associated with death at the end of follow-up.
Although re-hospitalization represents frequent phenomenon related to age, non-avoidable readmissions mainly involve female patients. ERA score appears to be an useful practical tool, able to identify high risk patients.
出院后再次入院被视为不良、严重且代价高昂的结果。在过去几年中，已经提出了两个新的评分系统来识别有再次入院高风险的患者，即医院评分（HOSPITAL）和老年人风险评估（ERA）指数。本研究的目的是评估这两个评分系统以及内科再次入院患者的死亡风险。
在30个月的期间内，我们从13237例入院患者中识别出613例再次入院患者。对年龄、性别、住院时间（LOS）和死亡情况进行了回顾性分析。诊断与首次住院一致的再次入院被归类为可避免的，而诊断不同的则被定义为不可避免的。计算了30天潜在可避免再次入院的医院评分和ERA指数。
再次入院患者（56.6%为女性），年龄为79±10.4岁。30天再次入院的发生率为20.4例/月。286例（46.7%）的再次住院可归类为可避免的，随访结束时记录到366例（59.7%）死亡。医院评分≥7分和ERA评分≥16分均能够识别再次入院高风险患者，分别出现在108例（17.6%）和385例（64.4%）病例中。不可避免再次入院的患者比可避免再次入院的患者年龄更大、女性更常见、患有糖尿病且ERA评分更高。多因素逻辑回归分析显示，不可避免再次入院与女性性别（比值比[OR]1.410[95%置信区间（CI）1.012 - 1.964]，p = 0.042）和年龄（OR 1.025[95%CI 1.006 - 1.043]，p = 0.01）独立相关，而在随访结束时，只有年龄（OR 1.034[95%CI 1.015 - 1.054]，p < 0.001）和ERA评分（OR 1.047[95%CI 1.001 - 1.095]，p = 0.047）与死亡独立相关。
尽管再次住院是与年龄相关的常见现象，但不可避免的再次入院主要涉及女性患者。ERA评分似乎是一个有用的实用工具，能够识别高风险患者。
