To examine the influence of race on 7-day hospital readmission rates after discharge
of critically ill patients.
Racial status is a risk factor for early (within 7 days) hospital readmission after
initial recovery from critical illness and respiratory failure. This was a retrospective
cohort study that took place in a 350-bed community hospital. Adult patients who received
mechanical ventilation during their intensive care unit stay were included. Study
subjects were categorized as white, black (non-Hispanic), Hispanic, and Asian/other.
The main outcome measure was readmission to the hospital within 7 days of discharge.
Secondary outcomes were hospital mortality and durations of hospital and intensive
care unit stay. Comparisons were made across racial groups.
Of 772 patients, 172 (22.3%) died, and 96 of the 591 discharged patients (16.2%) were
readmitted within 7 days. Race was not a determinant of rapid readmission: 11.6% of
blacks (P = .2), 20.6% of Hispanics (P = .3) and 16.5% of whites were readmitted within 7 days. Readmitted patients were more
likely to have been discharged to a rehabilitation or extended care facility rather
than to home (22.1% vs 2.2%, P < .0001). Readmitted patients tended to have had prolonged duration of mechanical
ventilation ≥ 30 days (41% vs 15.1%, P = .004), to be aged ≥ 80 years (24.4% vs 13.9%, P = .005), and to be female (19.5% vs 13.7%, P = .04). Multivariate logistic regression analyses demonstrated that discharge to a place
other than home (odds ratio 10.1, 95% confidence interval 3.6–28.3) and prolonged
duration of mechanical ventilation (odds ratio 2.8, 95% confidence interval 1.1–6.9)
were independently associated with readmission. Race did not significantly influence
in-hospital mortality. Overall, the deceased were older and more likely to be female,
and had longer durations of mechanical ventilation and medical and surgical intensive
care unit stays.
Contrary to our hypothesis, race was not associated with rapid readmission or mortality
of critically ill patients. Factors independently associated with rapid readmission
were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation
or skilled nursing facility. Further studies are required to ascertain whether these
factors are generalizable or idiosyncratic to our institution.