Lawrence Hannah, McKeever Tricia M, Lim Wei Shen
Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK.
Thorax. 2023 Dec;78(12):1254-1261. doi: 10.1136/thorax-2022-219925. Epub 2023 Jul 31.
Readmission rates following hospital admission with community-acquired pneumonia (CAP) have increased in the UK over the past decade. The aim of this work was to describe the cohort of patients with emergency 30-day readmission following hospitalisation for CAP in England and explore the reasons for this.
A retrospective analysis of cases from the British Thoracic Society national adult CAP audit admitted to hospitals in England with CAP between 1 December 2018 and 31 January 2019 was performed. Cases were linked with corresponding patient level data from Hospital Episode statistics, providing data on the primary diagnosis treated during readmission and mortality. Analyses were performed describing the cohort of patients readmitted within 30 days, reasons for readmission and comparing those readmitted and primarily treated for pneumonia with other diagnoses.
Of 8136 cases who survived an index admission with CAP, 1304 (15.7%) were readmitted as an emergency within 30 days of discharge. The main problems treated on readmission were pneumonia in 516 (39.6%) patients and other respiratory disorders in 284 (21.8%). Readmission with pneumonia compared with all other diagnoses was associated with significant inpatient mortality (15.9% vs 6.5%; aOR 2.76, 95% CI 1.86 to 4.09, p<0.001). A diagnosis of hospital-acquired infection was more frequent in readmissions treated for pneumonia than other diagnoses (22.1% vs 3.9%, p<0.001).
Pneumonia is the most common condition treated on readmission following hospitalisation with CAP and carries a higher mortality than both the index admission or readmission due to other diagnoses. Strategies to reduce readmissions due to pneumonia are required.
在过去十年中，英国社区获得性肺炎（CAP）住院后的再入院率有所上升。这项研究的目的是描述英格兰因CAP住院后30天内紧急再入院的患者队列，并探究其原因。
对2018年12月1日至2019年1月31日期间在英格兰医院因CAP入院的英国胸科学会全国成人CAP审计病例进行回顾性分析。病例与医院事件统计中的相应患者层面数据相关联，提供了再入院期间治疗的主要诊断和死亡率数据。进行分析以描述30天内再入院的患者队列、再入院原因，并将因肺炎再入院并主要接受肺炎治疗的患者与其他诊断的患者进行比较。
在8136例CAP首次入院存活的病例中，1304例（15.7%）在出院后30天内作为急诊再次入院。再入院时治疗的主要问题是516例（39.6%）患者的肺炎和284例（21.8%）患者的其他呼吸系统疾病。与所有其他诊断相比，肺炎再入院与显著的住院死亡率相关（15.9%对6.5%；调整后比值比2.76，95%置信区间1.86至4.09，p<0.001）。肺炎再入院患者中医院获得性感染的诊断比其他诊断更频繁（22.1%对3.9%，p<0.001）。
肺炎是CAP住院后再入院时最常见的治疗疾病，其死亡率高于首次入院或因其他诊断再入院的情况。需要采取策略来降低因肺炎导致的再入院率。
