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Association between hospital admission either directly or via the emergency department, and readmission rates at 30 days in older adults in two rural hospitals: a retrospective cohort study

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Abstract

Introduction

Older patients are frequently re-admitted to the hospital after attending the emergency department (ED). We investigated whether direct admission to the hospital was associated with a lower risk of readmission at 30 days compared to admission via the ED, in patients aged ≥ 75 years.

Methods

Retrospective multicenter cohort study from 01/01/2018 to 31/12/2019, including patients aged ≥ 75 years from two hospitals. Patients admitted directly were matched 1:1 with patients admitted via the ED for center, age category, sex, major diagnosis category, type of stay (medical/surgical), and severity. We compared readmission at 30 days (primary outcome) and length of stay (secondary outcome) between groups.

Results

A total of 1486 matched patients with an available outcome measure were included for analysis. We observed no significant difference in 30-day readmission rate between those admitted directly (102/778, 13.1%) and those admitted via the ED (87/708, 12.3%, p = 0.63). There was a significant difference in length of stay between both groups: median 5 days [Q1–Q3: 2–8] vs 6 days [2–11] for direct and ED admissions, respectively (effect size: 0.11, p < 0.001). By multivariate analysis, only moderate to severe denutrition was associated with the risk of readmission at 30 days (Odds Ratio 2.133, 95% Confidence Interval 1.309–3.475).

Conclusion

The mode of entry to the hospital of patients aged 75 years and older was not associated with the risk of readmission at 30 days. However, those admitted directly had a significantly shorter length of stay than those admitted via the ED.

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Data availability

All data supporting the findings of this study are available within the paper and its supplementary information.

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Acknowledgements

The authors would like to thank Dr Christian Alba and Dr Anne Marilliet-Mouallem for handling organizational and administrative aspects of the Chaumont center.

Funding

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Authors and Affiliations

  1. General Medicine Department, Champagne Ardennes University, Reims, France

    Michaël Gaston

  2. University Committee of Resources for Research in Health (CURRS), University of Reims Champagne-Ardenne, Reims, France

    Leila Bouazzi & Stéphane Sanchez

  3. EA3920, University of Franche-Comté, Besancon, France

    Fiona Ecarnot

  4. Geriatric Medicine Department, Troyes Hospital Center, Troyes, France

    Michèle Collard

  5. URCA, EA3797, VieFra, Reims, France

    Jean-Luc Novella & Stéphane Sanchez

  6. Geriatric Medicine Department, Reims University Hospital, Reims, France

    Jean-Luc Novella

  7. Department of Public Health, Champagne Sud Hospital, Troyes, France

    Stéphane Sanchez & Jan Chrusciel

  8. Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besancon, France

    Fiona Ecarnot

Authors
  1. Michaël Gaston
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  5. Jean-Luc Novella
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Contributions

MG and SS designed the study. The data were acquired and curated by MG, LB, and JC. Formal analysis was performed by LB and JC. MG, FE and SS wrote the first manuscript. JC, LB, SS, JLN, MG, and MC interpreted the data. JC, JLN, JLN, MC, and FE revised the manuscript for critical intellectual content. FE translated the article from French to English. Statistical aspects of methodology were developed by LB and JC. All authors had access to the study data and have approved the final manuscript for submission, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Fiona Ecarnot.

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Conflict of Interest

No author has any conflict of interest to declare.

Ethical approval

In compliance with French legislation governing non-interventional, retrospective studies, approval from an Ethics Committee and informed consent were not required. All data were anonymous and the study was registered with the National Authority for Data Privacy (N° F20210713164842).

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Gaston, M., Bouazzi, L., Ecarnot, F. et al. Association between hospital admission either directly or via the emergency department, and readmission rates at 30 days in older adults in two rural hospitals: a retrospective cohort study. Aging Clin Exp Res 35, 2703–2710 (2023). https://doi.org/10.1007/s40520-023-02543-3

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  • DOI: https://doi.org/10.1007/s40520-023-02543-3

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