Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy

• Published in: BMC geriatrics Vol. 23; no. 1; p. 154
• Main Authors: Trevisan, Caterina, Noale, Marianna, Zatti, Giancarlo, Vetrano, Davide Liborio, Maggi, Stefania, Sergi, Giuseppe
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.03.2023; BioMed Central; BMC
• Subjects: 30-day readmission; Age; Aged; Arthritis; Body mass index; Chronic illnesses; Chronic obstructive pulmonary disease; Cohort analysis; Cohort Studies; Electronic health records; Female; Frailty; Generalized linear models; Geriatrics; Hospital readmission; Hospitalization; Hospitals; Humans; Hypertension; Italy - epidemiology; Length of Stay; Living arrangements; Male; Medicin och hälsovetenskap; Nursing homes; Older people; Patient Readmission; Regression analysis; Retrospective Studies; Sensitivity analysis; Sociodemographics; Trends; Variables; Vein & artery diseases; Italy; Sweden; 30-day readmission; Hospitalization; Hospital readmission; Length of stay
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-023-03884-4

There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03). The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.