||Objectives: This Study wanted to analysis the characteristics of the elder adult who had hospitalized with pneumonia. We also evaluated the factors that will affect the unexpected readmission in elderly pneumonia patients.|
Methods: This is a retrospective cohort study design. The study data was collected 341 pneumonia patients who have hospitalized in a general teaching hospital in Kaohsiung city from year 2009 to 2010. The study population was divided into two groups, the sample size of the old group (age >= 65yrs), and the young group (age < 65yrs) was 173 and 168, respectively. The methods of stepwise multiple logistic regressions were needed to evaluate the association between aging and different days of unplanned readmission in adult pneumonia patients.
Results: All the 341 adult pneumonia patients, we found 613 male and 926 female. The demography characteristic of the study subjects, the means of age was 61.9yrs (s.d. = 19.3yrs), and BMI was 23.4 kg/m2 (s.d. = 4.5 kg/m2). The percentage of ICD-9-CM that code 486 was 95.6%. Most patients were community-acquired pneumonia (98.8%), hospitalized from emergency room (85.3%), and admission in general wards (92.7%). The unplanned readmission within 14/30 days, 60 days, and 90days were 9.1%, 11.7%, and 15.0%, respectively. The significant factors that were associated with readmission within 14 days include age, Hb, hospitalized days, hypertension, and other disease. When we used the multiple logistic regression analysis to adjust the other variables, only age still significant with readmission within 14 days (the crude OR of the old group was 4.561, adjusted OR was 2.714, 95% CI of OR from 1.002 to 7.353). In the stepwise multiple logistic regression models, the variable that was associated with readmission with 14 or 30 days were age (>= 65yrs, OR = 3.025), WBC (>=10750 mm3, OR=2.917), and Hb (>=12.4 g/dL, OR=0.390). We remain the elderly subjects to evaluate the factor that will influence readmission states. In all the stepwise logistic regression models, we found the experience with used endotracheal tube in the hospitalized period were the significant increases the readmission rate within 14 or 30 days, 60 days, and 90 days.
Conclusion: In our study shows that the situations of unexpected readmission in pneumonia patients were strong association with aging. We suggest that the indicator of medical quality should be adjusted before we comparison the readmission rate in the different institute. The major factors that will be associated to affect the readmission states were endotracheal tube used (significant with 14 or 30 days readmission rate), CRP level (significant with 60 days and 90 days readmission rate), and Hb level (significant with 60 days and 90 days readmission rate).