Butala Anvi, Gilbert Jacqueline M, Griffiths Alyssa A, Lim Wen K
Department of Geriatrics, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
Eur Geriatr Med. 2025 Feb;16(1):271-280. doi: 10.1007/s41999-024-01084-w. Epub 2024 Nov 14.
Inpatient delirium and unplanned hospital readmissions are associated with increased mortality. This study aimed to determine the effect of 28-day unplanned hospital readmissions on 12-month mortality post-discharge in patients with delirium during index hospitalisation.
Retrospective longitudinal cohort study of adults aged 65 or above with delirium during hospitalisation at a Victorian quaternary hospital was performed. Delirium was identified by the inclusion of ICD-10 (International Classification of Diseases, 10th revision) codes in the hospital medical discharge summary. Descriptive statistics was obtained for baseline characteristics. Cox proportional hazards model was developed to identify independent predictors of 12-month post-discharge mortality.
One thousand six hundred thirty-four patients with delirium during in-patient admission were included. The overall 12-month mortality rate was 35% (572 patients). Of the 1,425 patients who survived their index admission, 11.2% had an unplanned 28-day readmission. In Cox regression analysis, unplanned readmission (hazard ratio (HR) 2.3, 95% confidence internal (CI) 1.7-2.9), older age (HR 1.38, CI 1.11-1.72), Charlson Comorbidity Index (HR 1.21, CI 1.17-1.27), and discharge to nursing home (HR 1.58, CI 1.23-2.02) were independent predictors of 12-month mortality. Readmitted patients with 12-month mortality were older, with higher rates of dementia, polypharmacy, and nursing home residence compared to readmitted patients who did not reach this endpoint.
Unplanned hospital readmission within 28 days of discharge is an independent predictor of 12-month mortality post in-hospital delirium admission. Admissions complicated by delirium and readmission episodes should instigate discussions regarding prognostication and goals of care. Greater research is required to minimise hospital readmission rates following discharge in this cohort.
住院期间的谵妄和非计划的再次入院与死亡率增加相关。本研究旨在确定在首次住院期间发生谵妄的患者中，28天非计划再次入院对出院后12个月死亡率的影响。
对一家维多利亚州四级医院中65岁及以上住院期间发生谵妄的成年人进行回顾性纵向队列研究。通过在医院医疗出院小结中纳入ICD - 10（国际疾病分类第10版）编码来识别谵妄。获取基线特征的描述性统计数据。建立Cox比例风险模型以识别出院后12个月死亡率的独立预测因素。
纳入1634例住院期间发生谵妄的患者。总体12个月死亡率为35%（572例患者）。在首次入院存活的1425例患者中，11.2%有非计划的28天再次入院。在Cox回归分析中，非计划再次入院（风险比（HR）2.3，95%置信区间（CI）1.7 - 2.9）、年龄较大（HR 1.38，CI 1.11 - 1.72）、Charlson合并症指数（HR 1.21，CI 1.17 - 1.27）以及出院至养老院（HR 1.58，CI 1.23 - 2.02）是12个月死亡率的独立预测因素。与未达到该终点的再次入院患者相比，12个月内死亡的再次入院患者年龄更大，痴呆、多种药物治疗和居住在养老院的比例更高。
出院后28天内的非计划再次入院是住院谵妄入院后12个月死亡率的独立预测因素。伴有谵妄的入院和再次入院情况应引发关于预后和护理目标的讨论。需要更多研究以尽量降低该队列出院后的再次入院率。
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