Dataset Information

Newborn Length of Stay and Risk of Readmission.

ABSTRACT:

Background

Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14.

Methods

The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day).

Results

Of 4 667 827 babies, 5.2% were readmitted within 30 days. Aggregated data showed hospitals with longer mean LOS were not associated with lower readmission rates for vaginal (adjusted risk ratio (aRR) 0.87, 95% confidence interval (CI) 0.66, 1.13), or caesarean (aRR 0.89, 95% CI 0.72, 1.12) births. LOS fell by an average 2.0% per year for vaginal births and 3.4% for caesarean births, while readmission rates increased by 4.4 and 5.1% per year respectively. Approaches (iii) and (iv) indicated that longer LOS was associated with a reduced risk of readmission, but only for late preterm, vaginal births (34-36 completed weeks' gestation).

Conclusions

Longer newborn LOS may benefit late preterm babies, possibly due to increased medical or psychosocial support for those at greater risk of potentially preventable readmissions after birth. Research based on observational data to evaluate relationships between LOS and readmission should use methods to reduce the impact of unmeasured confounding.

SUBMITTER: Harron K

PROVIDER: S-EPMC5518288 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Newborn Length of Stay and Risk of Readmission.

Harron Katie K Gilbert Ruth R Cromwell David D Oddie Sam S van der Meulen Jan J

Paediatric and perinatal epidemiology 20170418 3

<h4>Background</h4>Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14.<h4>Methods</h4>The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trend ...[more]

PMID: 28418622

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Project description:Objective: How hospital length of stay after delivery for women with preeclampsia is associated with risk for readmission is unknown. The objective of this study was to evaluate risk for 60-day hypertension-related postpartum readmission based on length of stay after delivery.Methods: The 2014 Healthcare Cost and Utilization Project's (HCUP) Nationwide Readmissions Database was used to analyze risk for readmission for a hypertension-related diagnosis within 60 days from cesarean delivery hospitalization for women with preeclampsia who underwent cesarean delivery. Risk for readmission was evaluated based on postoperative length of stay as well as demographic, hospital, and other obstetric factors. Population weights were applied to create national estimates. Multivariable analyses were performed with adjusted risk ratios (aRR) and corresponding 95% confidence intervals as measures of effect. Mean and median hospital charges based upon postoperative length of stay were also evaluated. Time from delivery hospitalization to readmission was calculated.Results: In 2014, 65 401 women with preeclampsia underwent cesarean delivery. Of these, 1016 women (1.6%) were readmitted for a hypertension-related diagnosis. 921 of the 1016 readmissions occurred within 10 days of discharge (90.6%). In adjusted analyses, postoperative LOS 5-7 days and >7 days compared to LOS <3 days were associated with decreased risk of 60-day hypertension-related readmission (aRR 0.59 95% CI 0.45, 0.78; aRR 0.53 95% CI 0.29, 1.00, respectively). When the cohort was restricted to women with severe preeclampsia or eclampsia, LOS 5-7 days was associated with decreased risk of 60-day hypertension-related readmission in both unadjusted and adjusted analyses compared to LOS <3 days (risk ratios (RR) 0.34, 95% CI 0.18, 0.65; aRR 0.29, 95% 0.18, 0.46, respectively). Median delivery hospitalization charges were $26 512. Compared to LOS <3 days, mean and median charges increased significantly for patients with LOS 4, 5-7, and >7 days.Conclusion: Longer postoperative length of stay during cesarean delivery hospitalizations was associated with decreased risk for postpartum hypertension-related readmission. Most readmissions occurred soon after discharge. These findings support that post-delivery management may play a role in likelihood of women requiring subsequent readmission for complications related to preeclampsia after discharge.

Project description:BackgroundThe population of persons seeking medical care is linguistically diverse in the United States. Language barriers can adversely affect a patient's ability to explain their symptoms. Among hospitalized patients, these barriers may lead to higher readmission rates and longer hospitalizations. Trained interpreters help overcome communication barriers; however, interpreter usage among patients is suboptimal.ObjectiveTo investigate differences among patients with limited English proficiency (LEP) in their length of stay (LOS) and 30-day readmission rate associated with their receiving professional interpretation at admission or discharge.DesignWe analyzed the rates of interpretation at admission and discharge of all LEP patients admitted to a tertiary care hospital over a three-year period. We calculated length of stay in days and as log of LOS. We also examined 30-day readmission. Using multivariable regression models, we explored differences among patients who received interpretation at admission, discharge, or both, controlling for patient characteristics, including age, illness severity, language, and gender.ParticipantsAll LEP patients admitted between May 1, 2004 and April 30, 2007.Main measuresLength of hospital stay as related to use of professional interpreters; readmission to the hospital within 30 days.Key resultsOf the 3071 patients included in the study, 39 % received language interpretation on both admission and discharge date. Patients who did not receive professional interpretation at admission or both admission/discharge had an increase in their LOS of between 0.75 and 1.47 days, compared to patients who had an interpreter on both day of admission and discharge (P<0.02). Patients receiving interpretation at admission and/or discharge were less likely than patients receiving no interpretation to be readmitted with 30 days.ConclusionsThe length of a hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or both admission/discharge.

Dataset Information

Newborn Length of Stay and Risk of Readmission.

Background

Methods

Results

Conclusions

Publications

Newborn Length of Stay and Risk of Readmission.

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