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. 2019 Jun 13;19(1):738.
doi: 10.1186/s12889-019-7066-9.

Patterns of multimorbidity associated with 30-day readmission: a multinational study

Carole E Aubert  1   2 , Jeffrey L Schnipper  3   4 , Niklaus Fankhauser  5 , Pedro Marques-Vidal  6 , Jérôme Stirnemann  7 , Andrew D Auerbach  8 , Eyal Zimlichman  9 , Sunil Kripalani  10   11 , Eduard E Vasilevskis  10   12 , Edmondo Robinson  13 , Joshua Metlay  14 , Grant S Fletcher  15 , Andreas Limacher  5 , Jacques Donzé  16   4   17
Affiliations

Patterns of multimorbidity associated with 30-day readmission: a multinational study

Carole E Aubert et al. BMC Public Health. .

Abstract

Background: Multimorbidity is associated with higher healthcare utilization; however, data exploring its association with readmission are scarce. We aimed to investigate which most important patterns of multimorbidity are associated with 30-day readmission.

Methods: We used a multinational retrospective cohort of 126,828 medical inpatients with multimorbidity defined as ≥2 chronic diseases. The primary and secondary outcomes were 30-day potentially avoidable readmission (PAR) and 30-day all-cause readmission (ACR), respectively. Only chronic diseases were included in the analyses. We presented the OR for readmission according to the number of diseases or body systems involved, and the combinations of diseases categories with the highest OR for readmission.

Results: Multimorbidity severity, assessed as number of chronic diseases or body systems involved, was strongly associated with PAR, and to a lesser extend with ACR. The strength of association steadily and linearly increased with each additional disease or body system involved. Patients with four body systems involved or nine diseases already had a more than doubled odds for PAR (OR 2.35, 95%CI 2.15-2.57, and OR 2.25, 95%CI 2.05-2.48, respectively). The combinations of diseases categories that were most strongly associated with PAR and ACR were chronic kidney disease with liver disease or chronic ulcer of skin, and hematological malignancy with esophageal disorders or mood disorders, respectively.

Conclusions: Readmission was associated with the number of chronic diseases or body systems involved and with specific combinations of diseases categories. The number of body systems involved may be a particularly interesting measure of the risk for readmission in multimorbid patients.

Keywords: Diseases combinations; Multimorbidity; Potentially avoidable readmission; Readmission.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Odds ratios with 95% confidence intervals for a) potentially avoidable readmission and b) all-cause readmission according to the number of chronic diseases. The reference is the presence of two chronic diseases, as we included only patients with multimorbidity. Abbreviations: #, number of chronic diseases; CI, confidence interval; N, number of patients; OR, odds ratio
Fig. 2
Fig. 2
Odds ratios with 95% confidence intervals for a) potentially avoidable readmission and b) all-cause readmission according to the number of body systems involved. Abbreviations: #, number of body systems; CI, confidence interval; N, number of patients; OR, odds ratio
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