Thirty-Day Readmission Among Patients With Non-Ventilator Hospital Acquired Pneumonia and Effects on Outcomes

Abstract

We determine the rate of hospital readmission within 30 days of non-ventilator hospital acquired pneumonia (NV-HAP) and its impact on mortality, morbidity, and health care use in the United States. A retrospective study was conducted using the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (14.9 million hospital stays at 2048 hospitals in 22 states).

86,601 adulthospital admissions were identified for NV-HAP and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using logistic regression analysis.

The 30-day rate of readmission was 12.6%. 51%of readmissions were due to recurrent Pneumonia, followed by sepsis (40%). The rate of death among patients readmitted to the hospital (21%) was lower than that for index admissions (26%) (P<.01). A total of 189,293 hospital days was associated with readmission, and the total health care in-hospital economic burden was $426 million (in costs) and $1.57 billion (in charges). Independent predictors of readmission were advanced age, income, insurance, discharged from university hospitals, discharge to rehabilitation facility, and advanced Charlson comorbidity index.

In this retrospective study of patients hospitalized for NV-HAP, readmission is associated with a high mortality, morbidity, and resource use.