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RF14 A systematic review of 30-day readmissions in adults hospitalised with community-acquired pneumonia
  1. AM Klukowska1,
  2. WS Lim2,
  3. T McKeever1,
  4. H Pick1,2,
  5. D Ashton2
  1. 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  2. 2Division of Respiratory Medicine, University of Nottingham, Nottingham, UK


Background Community-acquired pneumonia (CAP) is one of the most common communicable diseases worldwide associated with significant levels of morbidity and mortality causing a substantial economic burden. 30-day hospital readmission rate is often used as a secondary outcome in studies of CAP. This data can be used to define the burden of disease and the reasons for readmissions potentially amenable to intervention.

A systematic review and random meta-analysis were conducted to estimate the pooled 30-day readmission rate of adult patients with CAP and 30-day pneumonia-related/non-pneumonia-related and cardiovascular-related readmission rates of such patients.

Methods MEDLINE, EMBASE, AMED (until October 2017) and reference lists of papers were searched to identify studies of CAP including 30-day hospital readmission rate of adult patients. Each step of the study selection process was conducted by two independent reviewers. The quality was assessed using a pre-tested form based on the Newcastle-Ottawa Scale. Pooled proportions of patients readmitted within 30 days with 95% confidence intervals (CI), were estimated. Additional subgroup analyses were conducted.

Results A total of 63 studies were included in the statistical analysis, covering the period from 1994 to 2017. The pooled 30-day readmission rate estimate was 0.10 (CI 0.08–0.11). High levels of heterogeneity were identified, I2=98.95%. Only two subgroups analysis reported statistically significant differences (p-value <0.05). Retrospective studies had a higher readmission rate of 0.12 (95% CI 0.10 to 0.14, I2=99.39%) compared to prospective studies, 0.07 (95% CI 0.06 to 0.09, I2=93.35%). Europe had significantly lower 30-day readmission rate, 0.08 (95% CI 0.07 to 0.10, I2=94.98%) than North America, which reported 0.11 (95% CI 0.09 to 0.14, I2=99.50%). Non-pneumonia-related readmissions accounted for 0.60 (95% CI 0.48 to 0.72, I2=89.00%) of all 30-day readmissions. Additionally, 0.31 (95% CI 0.25 to 0.37, I2=79.74%) of 30-day readmissions were pneumonia-related, while 0.20 (95% CI 0.14 to 0.26, I2=33.55%) were cardiovascular-related. The studied populations were mostly composed of elderly patients. High levels of heterogeneity may have been due to different selection criteria of included studies and variations among health-care systems and treatment practices.

Conclusion Among all adult patients with CAP, 10% are readmitted to the hospital within 30 days. The majority of all-cause readmissions are non-pneumonia-related, specifically 20% are cardiovascular related. Only one third of 30-day readmissions are due to pneumonia.

  • community-acquired pneumonia
  • readmission
  • adult

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