Among patients hospitalized for community acquired pneumonia (CAP) in the United Kingdom (UK), emergency 30-day readmissions were high, largely due to recurring pneumonia, according to study findings published in Thorax.
While mortality among patients hospitalized for CAP decreased in the UK from 2009 to 2019, the 30-day emergency readmission rates among these patients trended up during that same period. Investigators sought to characterize patients in the UK with 30-day emergency readmission following hospitalization for CAP and to identify reasons for readmissions.
The researchers conducted a retrospective, descriptive, cohort analysis using data from the British Thoracic Society (BTS) national adult CAP audit of adults with CAP admitted to hospitals in the UK from December 2018 through January 2019. These data were linked with related data from Hospital Episode statistics (which provides data on the primary diagnosis treated during readmission) for the cohort of patients readmitted within 30 days of discharge.
Among the 8136 patients who survived the index admission with CAP, investigators found 1304 (15.7%) were readmitted on an emergency basis within 30 days of discharge. Patients readmitted vs those not readmitted tended to be older (78 vs 73 years of age) and were more likely to have comorbidities such as cardiac failure (14.5% vs 8.2%), chronic obstructive pulmonary disease (COPD; 32.0% vs 23.9%), and dementia (12.5% vs 9.6%). Patients readmitted vs those not readmitted were also more likely at their index admission to have a higher severity of CAP (28.1% vs 20.2%) and greater median length of stay (5 days vs 4 days), and were more likely to be discharged to a residential or care home (4.8% vs 3.1%) and less likely to have arranged any planned follow-up (61.9% vs 67.4%).
Pneumonia is the most common condition treated on readmission following hospitalization with CAP and carries a higher mortality than both the index admission or readmission due to other diagnoses.
The most common diagnoses treated on readmission were:
- pneumonia (n=516, including 39.5% of all readmissions and 64.5% of all respiratory readmissions);
- other respiratory disorders (n=284, including 21.8% of all readmissions, with the most common respiratory disorders being COPD [n=99], other lower respiratory tract infections [n=43], and influenza [n=32]);
- nonrespiratory diagnoses (n=239; most commonly cardiac failure [n=39], urinary tract infection [n=27], and acute renal failure [n=24]); and
- multiple other non-respiratory causes (n=265).
Significant in-hospital mortality was associated with readmission for pneumonia vs all other diagnoses (15.9% vs 6.5%; adjusted odds ratio, 2.76; 95% CI, 1.86-4.09; P <.001). Readmitted patients who were treated for pneumonia vs all other diagnoses had more frequent diagnosis of hospital-acquired infection (22.1% vs 3.9%; P <.001). Overall, 1207 patients died within 30 days of the index admission. The most common causes of inpatient death included pneumonia (n=260), COPD (n=160), and dementia (n=102). The most common causes of outpatient death within 90 days of index admission were COPD and dementia.
Study limitations include data coding errors, coding variations between hospitals, and missing clinical data in the BTS audit dataset.
“Pneumonia is the most common condition treated on readmission following hospitalization with CAP and carries a higher mortality than both the index admission or readmission due to other diagnoses,” the investigators concluded. “A high proportion of readmissions with pneumonia are associated with hospital-acquired infection. Strategies to prevent hospital-acquired infection in patients with pneumonia may be of benefit,” the study authors noted.