To identify modifiable risk factors of late unplanned readmissions for elderly with pneumonia.
Three university affiliated tertiary care hospitals A case control study was performed in three University affiliated tertiary care centers. Two hundred four case-control pairs were identified. Case patients referred to all patients readmitted with pneumonia 30 days to one year after discharge. Control subjects were matched for age, admission date, and residence prior to admission.
Median time to readmission was 123 days (IQR, 65-238 days). Readmission was not associated with increased severity or length of hospital stay. In a Cox proportional hazards regression model, swallowing dysfunction (HR, 2.15; 95% CI 1.46-2.97), current smoking (HR, 2.04; 95% CI 1.48-2.82), the use of tranquilizers (HR, 1.5; 95% CI 1.02-2.22), and lower activity of daily living (HR, 1.06; 95% CI 1.02-1.10) were independently associated with readmission for pneumonia. The receipt of angiotensin converting enzyme inhibitors (HR, 0.46; 95% CI 0.27-0.78) and prior pneumococcal vaccination (HR, 0.59; 95% CI 0.42-0.82) had a protective effect.
Routine evaluation of swallowing dysfunction and use of pharmacologic agents to improve the cough reflex deserve further evaluation in multicentered controlled trials.
While there are limited effective measures to improve functional status, preventive strategies that include smoking cessation and pneumococcal vaccination should be actively pursued.
A.A. El Solh, None.