Introduction.
Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of
hospital readmission and designing interventions to reduce the rate of
hospital readmission.
Malnutrition is a known risk factor for
hospital readmission. Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of
serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission
serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a
serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having
protein energy malnutrition. The primary outcome investigated in this study was
hospital readmission for any reason within 30 days of discharge. Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge.
Protein energy malnutrition was common in this population. Low
albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low
albumin and low TLC was found in 709 (42%) of patients. Kaplan-Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of
hospital readmission. Low
serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low
serum albumin (Hazard Ratio 3.27, 95% CI [2.30-4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03-1.38]) to be significant independent predictors of
hospital readmission within 30 days. Discussion. This study investigated the relationship of PEM to the rate of
hospital readmission within 30 days of discharge in patients 65 years of age or older. These results indicate that
laboratory markers of PEM can identify patients at risk of
hospital readmission within 30 days of discharge. This risk determination is simple and identifies a potentially modifiable risk factor for readmission:
protein energy malnutrition.