DOI QR코드

DOI QR Code

Reasons and Risk Factors for Readmission Following Hospitalization for Community-acquired Pneumonia in South Korea

  • Jang, Jong Geol (Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Ahn, June Hong (Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine)
  • Received : 2019.10.15
  • Accepted : 2019.12.06
  • Published : 2020.04.30

Abstract

Background: Limited studies have been performed to assess readmission following hospitalization for community-acquired pneumonia (CAP) in an Asian population. We evaluated the rates, reasons, and risk factors for 30-day readmission following hospitalization for CAP in the general adult population of Korea. Methods: We performed a retrospective observational study of 1,021 patients with CAP hospitalized at Yeungnam University from March 2012 to February 2014. The primary end point was all-cause hospital readmission within 30 days following discharge after the initial hospitalization. Hospital readmission was classified as pneumonia-related or pneumonia-unrelated readmission. Results: During the study period, 862 patients who survived to hospital discharge were eligible for inclusion and among them 72 (8.4%) were rehospitalized within 30 days. In the multivariable analysis, pneumonia-related readmission was associated with para/hemiplegia, malignancy, pneumonia severity index class ≥4 and clinical instability ≥1 at hospital discharge. Comorbidities such as chronic lung disease and chronic kidney disease, treatment failure, and decompensation of comorbidities were associated with the pneumonia-unrelated 30-day readmission rate. Conclusion: Rehospitalizations within 30 days following discharge were frequent among patients with CAP. The risk factors for pneumonia-related and -unrelated readmission were different. Aspiration prevention, discharge at the optimal time, and close monitoring of comorbidities may reduce the frequency of readmission among patients with CAP.

Keywords

References

  1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72. https://doi.org/10.1086/511159
  2. Shin HY, Lee JY, Song J, Lee S, Lee J, Lim B, et al. Cause-ofdeath statistics in the Republic of Korea, 2014. J Korean Med Assoc 2016;59:221-32. https://doi.org/10.5124/jkma.2016.59.3.221
  3. Choi MJ, Song JY, Noh JY, Yoon JG, Lee SN, Heo JY, et al. Disease burden of hospitalized community-acquired pneumonia in South Korea: analysis based on age and underlying medical conditions. Medicine (Baltimore) 2017;96:e8429. https://doi.org/10.1097/MD.0000000000008429
  4. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 2013;309:355-63. https://doi.org/10.1001/jama.2012.216476
  5. Dharmarajan K, Wang Y, Lin Z, Normand ST, Ross JS, Horwitz LI, et al. Association of changing hospital readmission rates with mortality rates after hospital discharge. JAMA 2017;318:270-8. https://doi.org/10.1001/jama.2017.8444
  6. Lee JE, Kim TH, Cho KH, Han KT, Park EC. The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea. BMC Health Serv Res 2017;17:393. https://doi.org/10.1186/s12913-017-2352-7
  7. De Alba I, Amin A. Pneumonia readmissions: risk factors and implications. Ochsner J 2014;14:649-54.
  8. Ahn JH, Choi EY. Expanded A-DROP score: a new scoring system for the prediction of mortality in hospitalized patients with community-acquired pneumonia. Sci Rep 2018;8:14588. https://doi.org/10.1038/s41598-018-32750-2
  9. Charlson ME, Sax FL, MacKenzie CR, Fields SD, Braham RL, Douglas RG Jr. Assessing illness severity: does clinical judgment work? J Chronic Dis 1986;39:439-52. https://doi.org/10.1016/0021-9681(86)90111-6
  10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50. https://doi.org/10.1056/NEJM199701233360402
  11. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82. https://doi.org/10.1136/thorax.58.5.377
  12. Yandiola PPE, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009;135:1572-9. https://doi.org/10.1378/chest.08-2179
  13. Capelastegui A, Espana Yandiola PP, Quintana JM, Bilbao A, Diez R, Pascual S, et al. Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia. Chest 2009;136:1079-85. https://doi.org/10.1378/chest.08-2950
  14. Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS, et al. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 1998;279:1452-7. https://doi.org/10.1001/jama.279.18.1452
  15. Jasti H, Mortensen EM, Obrosky DS, Kapoor WN, Fine MJ. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis 2008;46:550-6. https://doi.org/10.1086/526526
  16. Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, et al. Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals. Clin Infect Dis 2013;57:362-7. https://doi.org/10.1093/cid/cit254
  17. Halm EA, Fine MJ, Kapoor WN, Singer DE, Marrie TJ, Siu AL. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med 2002;162:1278-84. https://doi.org/10.1001/archinte.162.11.1278
  18. Adamuz J, Viasus D, Camprecios-Rodriguez P, Canavate-Jurado O, Jimenez-Martinez E, Isla P, et al. A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia. Respirology 2011;16:1119-26. https://doi.org/10.1111/j.1440-1843.2011.02017.x
  19. Prescott HC, Sjoding MW, Iwashyna TJ. Diagnoses of early and late readmissions after hospitalization for pneumonia: a systematic review. Ann Am Thorac Soc 2014;11:1091-100. https://doi.org/10.1513/AnnalsATS.201404-142OC
  20. Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, et al. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: a systematic review with meta-analysis. Sci Rep 2016;6:38097. https://doi.org/10.1038/srep38097
  21. Harada J, Sekizawa K. Angiotensin-converting enzyme inhibitors and pneumonia in elderly patients with intracerebral hemorrhage. J Am Geriatr Soc 2006;54:175-6. https://doi.org/10.1111/j.1532-5415.2005.00575_8.x
  22. Caldeira D, Alarcao J, Vaz-Carneiro A, Costa J. Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. BMJ 2012;345:e4260. https://doi.org/10.1136/bmj.e4260
  23. Luk JK, Chan DK. Preventing aspiration pneumonia in older people: do we have the 'know-how'? Hong Kong Med J 2014;20:421-7.