30-day mortality of elderly medical patients after short-term acute admissions in Denmark - a nationwide cohort study.

30-day mortality of elderly medical patients after short-term acute admissions in Denmark – a nationwide cohort study.

Background. A growing number of older people with need of acute hospitalizations are expected in the future. Short hospital stays for elderly patients could reduce costs, crowding, and risk of adverse events related to hospitalization. However, mortality of elderly patients after early discharge from hospitals is sparsely described. Therefore, the aim of this study was to examine the 30-day mortality rate among elderly medical patients discharged ≤24 hours after admission, and to examine the impact of demographic factors, comorbidity and admission diagnoses on mortality.

Methods. All medical patients ≥ 65 years admitted acutely to Danish hospitals between 1 January 2013 and 30 June 2014 surviving a hospital stay of ≤24 hours were included. Data on mortality within 30 days, comorbidity, demographic factors and reasons for admission (discharge diagnoses) were obtained from the Danish National Registry of Patients and the Civil Registration System. We used Cox regression to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) for mortality. We examined potential predictors of 30-day mortality including age, gender, Charlson Comorbidity Index score (CCI), marital status, and discharge diagnosis.

Results. A total of 93,271 patients (49.5% male) with a median age of 75 years (interquartile range: 69-82 years), were acutely admitted with a medical diagnosis and discharged within 24 hours. A total of 2,749 patients (3.0%; 95% CI 2.8-3.1%) died in the 30-day period following discharge. The age groups (65-75 years as reference) 76-85 years (aHR 1.60; 1.45-1.75) and 86+ years (aHR 3.40; 3.04-3.70), male sex (aHR 1.24; 1.14-1.34), a Charlson Comorbidity Index (0 as reference) of 1-2 (aHR 2.17; 1.94-2.42) and 3+ (aHR 4.11; 3.69-4.59), and unmarried status (aHR 1.17; 1.08-1.28) increased the risk of 30-day mortality. Discharge diagnoses associated with increased risk of 30-day mortality were heart failure (aHR 1.50; 1.16-1.94), respiratory failure (aHR 2.79; 2.13-3.67), dehydration (aHR 2.89; 2.52-3.32), constipation (aHR 1.32; 1.03-1.68), anemia (aHR 1.47; 1.28-1.67), pneumonia (aHR 2.24;1.93-2.59), urinary tract infection (aHR 1.33; 1.14-1.55), dyspnea (aHR 1.50; 1.25-1.79) and suspicion of malignancy (aHR 2.08; 1.65-2.61). The symptom-diagnoses chest pain (aHR 0.31; 0.22-0.43), headache (aHR 0.20; 0.07-0.64) and vertigo (aHR 0.33; 0.21-0.52) were associated with a reduced risk of 30-day mortality.

Discussion and Conclusions. Three percent of the acutely admitted medical patients aged ≥65 years died within 30 days after early discharge. High age, male gender, the comorbidity burden, unmarried status and several primary discharge diagnoses were identified as predictors of 30-day mortality. The results of our study should be considered in future research and planning of the discharge process of elderly patients.