Factores predictores de reingreso hospitalario no planificado en pacientes dados de alta de una Unidad de Corta Estancia Médica

Abstract

To determine the independent factors that predict unplanned hospital readmission in patients who are admitted to a Short-Stay Medical Unit (SSMU). DESIGN AND FIELD OF THE STUDY: Prospective cohort. Sanitary area: 500,000 inhabitants. Patients who survived to an hospital admission in the SSMU of our hospital (n = 196, a = 0.05, d = 7). We studied demographic variables, social situation, history of previous admissions to hospital, from each patient. From the index admission we included diagnosis, severity of the disease, complications, type of admission and co-morbility. Validated tests were done to measure functional capability, grade of dependence and psychologic situation. After a three month interval readmission was determined if there had been an urgent admission to any hospital in a 10-day, 28-day or 3-month interval after discharge caused by the same principal diagnosis. A descriptive analysis of the variables was made, and a univariate analysis to stablish their association to readmission. The predicting factors for readmission were calculated by means of logistic regression. The 60.2% were males, the median of the age was 72 years. 75% started or carried out only primary school; 40% were single, separated or widowed; 12% lived alone and 1.5% in an institution. Principal diagnosis at the time of index admission were: chronic obstructive pulmonary disease, congestive cardiac failure, ischemic heart disease, asthma, pneumonia, cardiac arrhythmia and acute cerebrovascular disease. Readmission rate at 10, 28 days and 3 months was 3.6%, 9.7% and 13.3%, respectively. The independent predicting factor for readmission in the 10 days interval from discharge was the number of days of hospitalization in the last year (OR: 1.02, 95% CI: 1.0-1.05). For readmission in a 28-day and 3-month interval from discharge, the only independent predicting factor was the number of admissions to any hospital in the last 3 years (OR: 1.71, 95% CI: 1.32-2.22 and OR: 1.62, 95% CI: 1.28-2.05 respectively). From the studied factors, those that predict unplanned hospital readmission of patients discharged from a Short-Stay Medical Unit cannot be modified.