Mortality And Readmission In Mechanically Ventilated Patients With Pneumonia

Pneumonia-related 30-day readmission rates are publically reported as part of the Hospital Readmissions Reduction Program to improve quality of care for Medicare beneficiaries. We estimated the impact of pneumonia on inpatient mortality and 30-day readmission rates in mechanically ventilated (MV) patients. We performed a cohort study of MV patients using the Premier Inpatient database (July 2012 to June 2013). Patients on MV for >=1 day were included and classified based on those with a pneumonia-related diagnosis code and those without. Patients were followed for the entire period of their hospitalization. Inpatient mortality and rates of readmission for the thirty days post discharge were compared between the two groups using generalized linear models (GLMs). We estimated both outcomes using the binomial distribution, controlling for patient demographics, 3M™ All Patient Refined Diagnosis Related Group Severity and Mortality indices, and hospital characteristics. A total of 65,246 patients met criteria, of which 15,421 (23.6%) carried a pneumonia diagnosis. Pneumonia patients were older (64.2 vs 58.0 years, p<0.0001), more likely to be male (46.8% vs 45.3%, p=0.0012), white (72.4% vs 66.9%, p<0.0001), and on public insurance (75.6% vs 65.2%, p<0.0001). Comparing outcomes, pneumonia patients experienced significantly higher rates of mortality (25.5% vs. 18.1%, p<0.0001) and 30-day readmission (15.3% vs. 12.9%, p<0.0001). After adjustment for patient and institutional factors in the GLM regressions the risk of both outcomes remained statistically significant with odds ratios of 1.05 (95% CI: 1.01 to 1.10) for mortality and 1.11 (95% CI: 1.05 to 1.17) for 30-day readmission (p=0.024 and 0.0002, respectively). Pneumonia in MV patients increases the risk of mortality and 30-day readmissions. With penalties as high as 3% across all Medicare payments for readmission, efforts should continue to carefully evaluate the care of mechanically ventilated patients with pneumonia.