The Impact of Cardiovascular Disease,Inspiratory Pressure,and Hemoglobin Levels on Unplanned Readmissions of Home Ventilator Patients Prior to Discharge: A Retrospective Study

Abstract

Background:

Unplanned readmission, which was defined as unscheduled readmission after patients' discharge, is an important clinical quality index. The readmission rate in long-term ventilated patients was extremely high around 20%-40%, but relevant pre-discharge factors that affect such unplanned readmission were unknown. This study aims to investigate the characteristics and prognosis of unplanned readmissions among home-ventilated patients and analyze pre-discharge factors that influence such readmissions.

Methods:

This retrospective study was conducted at a medical center in Taipei, Taiwan. Hospitalization data of patients from 2013.01.01 to 2017.12.31 were collected using the hospital's Research Electronic Data Capture (REDcap) system. Institutional Review Board and Ethics Committee NTUH-REC No. (201901054RIND). A flow chart (Figure 1) depicts the patient selection process. Descriptive statistics were used to analyze demographic variables. Home ventilation patients were categorized into early and late unplanned hospital readmission groups based on a 30-day cutoff. Patients readmitted within 30 days after discharge were classified as early readmissions, while others were categorized as late readmissions.

Results:

The study found significant differences in weight, BMI, Charlson comorbidity index, ventilator days, and admission days between the early and late unplanned readmission groups. Importantly, unplanned readmissions occurred on average 15 days after discharge, with some even occurring as early as the second day. The multivariate logistic regression analysis categorized home mechanical ventilation patients into early and late unplanned readmission groups (Table 1). Patients with chronic cardiovascular disease had a higher odds ratio (OR: 4.535) for readmission within 30 days compared to those without. A maximum inspiratory pressure (P_Imax) of ≥30 cm H₂O was associated with a lower odds ratio (OR: 0.207) for readmission within 30 days compared to P_Imax <30 cm H₂O. Hemoglobin levels ≥10.1 g/dL were linked to a lower odds ratio (OR: 0.280) for readmission within 30 days compared to <10.1 g/dL.

Conclusions:

This study first revealed pre-discharge factors of unplanned readmission in home mechanical ventilation patients in Taiwan, which were hemoglobin level, inspiratory muscle strength, and still presenting chronic cardiovascular problems. Our results provide compelling evidence, unplanned hospital readmission was highly associated with the recovery conditions at pre-discharge during the previous hospitalization.