Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study

被引:26
|
作者
Turnbull, Angus J. [1 ]
Donaghy, Eddie [1 ,2 ]
Salisbury, Lisa [3 ]
Ramsay, Pamela [4 ]
Rattray, Janice [5 ]
Walsh, Timothy [1 ,2 ,6 ]
Lone, Nazir [1 ,2 ]
机构
[1] Univ Edinburgh, Deanery Clin Sci, Univ Dept Anaesthesia Crit Care & Pain Med, Edinburgh, Midlothian, Scotland
[2] Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland
[3] Queen Margaret Univ Edinburgh, Sch Hlth Sci, Musselburgh, Scotland
[4] Edinburgh Napier Univ, Sch Hlth & Social Care, Edinburgh, Midlothian, Scotland
[5] Univ Dundee, Sch Nursing & Hlth Sci, Dundee, Scotland
[6] Univ Edinburgh, MRC Ctr Inflammat Res, Edinburgh, Midlothian, Scotland
关键词
critical illness; drug interactions; emergency readmission; hospital readmission; intensive care; outcome; polypharmacy; DRUG-DRUG INTERACTIONS; RISK; PREVALENCE; ADMISSION; CARE;
D O I
10.1016/j.bja.2020.09.035
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. Methods: A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Results: Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). Conclusions: This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.
引用
收藏
页码:415 / 422
页数:8
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