Does race affect readmission to hospital after critical illness?

Abstract

Objective: To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients.

Methods: Racial status is a risk factor for early (within 7 days) hospital readmission after initial recovery from critical illness and respiratory failure. This was a retrospective cohort study that took place in a 350-bed community hospital. Adult patients who received mechanical ventilation during their intensive care unit stay were included. Study subjects were categorized as white, black (non-Hispanic), Hispanic, and Asian/other. The main outcome measure was readmission to the hospital within 7 days of discharge. Secondary outcomes were hospital mortality and durations of hospital and intensive care unit stay. Comparisons were made across racial groups.

Results: Of 772 patients, 172 (22.3%) died, and 96 of the 591 discharged patients (16.2%) were readmitted within 7 days. Race was not a determinant of rapid readmission: 11.6% of blacks (P = .2), 20.6% of Hispanics (P = .3) and 16.5% of whites were readmitted within 7 days. Readmitted patients were more likely to have been discharged to a rehabilitation or extended care facility rather than to home (22.1% vs 2.2%, P < .0001). Readmitted patients tended to have had prolonged duration of mechanical ventilation > or = 30 days (41% vs 15.1%, P = .004), to be aged > or = 80 years (24.4% vs 13.9%, P = .005), and to be female (19.5% vs 13.7%, P = .04). Multivariate logistic regression analyses demonstrated that discharge to a place other than home (odds ratio 10.1, 95% confidence interval 3.6-28.3) and prolonged duration of mechanical ventilation (odds ratio 2.8, 95% confidence interval 1.1-6.9) were independently associated with readmission. Race did not significantly influence in-hospital mortality. Overall, the deceased were older and more likely to be female, and had longer durations of mechanical ventilation and medical and surgical intensive care unit stays.

Conclusion: Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.