Abstract
BackgroundThe risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system.ObjectiveWe compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008–2010.MethodsWe estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population.ResultsAmong >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively.ConclusionsPatterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize vulnerability to specific conditions should be tailored to their underlying risks.
Highlights
Post-hospital syndrome describes a period of transient, generalized risk after hospital discharge.[1]
This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize vulnerability to specific conditions should be tailored to their underlying risks
Following hospitalization for heart failure (HF), does the timing of risk for recurrent HF differ from that of infections? How does the timing of risk for bleeding compare with renal dysfunction? Is the period of elevated risk prolonged for specific conditions that commonly result in readmission? Such information can be useful in understanding if recovery from acute illness varies by physiologic system
Summary
Post-hospital syndrome describes a period of transient, generalized risk after hospital discharge.[1]. A key unanswered question is whether the timing of vulnerability after hospital discharge varies for different medical conditions that commonly result in rehospitalization. Findings can guide future basic and translational work to elucidate mechanisms responsible for potential differences in the extent and timing of risk across conditions. This information can demonstrate if patients remain vulnerable to specific conditions after the immediate post-discharge period when clinical follow up grows less regular. The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system
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