Impact of Nursing Home Admission on In-hospital Mortality and Morbidity and Length of Stay: A Case-control Analysis

Overview

Journal Surg Pract Sci

Date 2025 Jan 23

PMID 39845639

Authors

Claudio Canal

Anne-Sophie Mittlmeier

Valentin Neuhaus

Hans-Christoph Pape

Mathias Schlogl

Affiliations

Soon will be listed here.

Abstract

Methods: We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.

Results: We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, = <0.004).

Conclusions: Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.

References

Fendrich K, van den Berg N, Siewert U, Hoffmann W . [Demographic change: demands on the health care system and solutions using the example of Mecklenburg-Western Pomerania]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010; 53(5):479-85. DOI: 10.1007/s00103-010-1051-x. View

Kronman A, Freund K, Hanchate A, Emanuel E, Ash A . Nursing home residence confounds gender differences in Medicare utilization an example of Simpson's paradox. Womens Health Issues. 2010; 20(2):105-13. PMC: 4471050. DOI: 10.1016/j.whi.2009.11.016. View

Michels G, Muller-Werdan U . [Intensive Care in Elderly Patients - Consideration of Age-Related Organ Dysfunction and Vulnerability]. Dtsch Med Wochenschr. 2019; 144(20):1411-1416. DOI: 10.1055/a-0646-7910. View

Gomes J, Dias R, de Barros J, Velasco I, Jacob Filho W . The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med. 2020; 20(1):47. PMC: 7291438. DOI: 10.1186/s12873-020-00341-y. View

Alvis B, Hughes C . Physiology Considerations in Geriatric Patients. Anesthesiol Clin. 2015; 33(3):447-56. PMC: 4556136. DOI: 10.1016/j.anclin.2015.05.003. View

Graverholt B, Forsetlund L, Jamtvedt G . Reducing hospital admissions from nursing homes: a systematic review. BMC Health Serv Res. 2014; 14:36. PMC: 3906881. DOI: 10.1186/1472-6963-14-36. View

Loeb M . Community-acquired pneumonia in older people: the need for a broader perspective. J Am Geriatr Soc. 2003; 51(4):539-43. DOI: 10.1046/j.1532-5415.2003.51165.x. View

CREDITOR M . Hazards of hospitalization of the elderly. Ann Intern Med. 1993; 118(3):219-23. DOI: 10.7326/0003-4819-118-3-199302010-00011. View

Bauer M, Fitzgerald L, Haesler E, Manfrin M . Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. J Clin Nurs. 2009; 18(18):2539-46. DOI: 10.1111/j.1365-2702.2008.02685.x. View

10.

Berlin C, Busato A, Rosemann T, Djalali S, Maessen M . Avoidable hospitalizations in Switzerland: a small area analysis on regional variation, density of physicians, hospital supply and rurality. BMC Health Serv Res. 2014; 14:289. PMC: 4091658. DOI: 10.1186/1472-6963-14-289. View

11.

. Report of the World Health Organization. Active ageing: a policy framework. Aging Male. 2002; 5(1):1-37. View

12.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014; 12(12):1495-9. DOI: 10.1016/j.ijsu.2014.07.013. View

13.

Hespanhol V, Barbara C . Pneumonia mortality, comorbidities matter?. Pulmonology. 2019; 26(3):123-129. DOI: 10.1016/j.pulmoe.2019.10.003. View

14.

Chao C, Lee S, Wang J, Chien K, Huang J . Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr. 2021; 21(1):349. PMC: 8186134. DOI: 10.1186/s12877-021-02299-3. View

15.

Ozturk R, Murt A . Epidemiology of urological infections: a global burden. World J Urol. 2020; 38(11):2669-2679. DOI: 10.1007/s00345-019-03071-4. View

16.

Gianino M, Lenzi J, Martorana M, Bonaudo M, Fantini M, Siliquini R . Trajectories of long-term care in 28 EU countries: evidence from a time series analysis. Eur J Public Health. 2017; 27(6):948-954. DOI: 10.1093/eurpub/ckx177. View

17.

Muller-Werdan U, Heppner H, Michels G . [Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine]. Med Klin Intensivmed Notfmed. 2018; 113(4):256-259. DOI: 10.1007/s00063-018-0440-z. View

18.

Mei F, Gao Q, Chen F, Zhao L, Shang Y, Hu K . Frailty as a Predictor of Negative Health Outcomes in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2020; 22(3):535-543.e7. DOI: 10.1016/j.jamda.2020.09.033. View

19.

van Dijk P, Bot A, Neuhaus V, Menendez M, Vrahas M, Ring D . Admission From Nursing Home Residence Increases Acute Mortality After Hip Fractures. Geriatr Orthop Surg Rehabil. 2015; 6(3):123-9. PMC: 4536497. DOI: 10.1177/2151458515570477. View

20.

Chen B, Lai F, Tsao L, Chien H, Chen C, Jeng C . Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study. J Adv Nurs. 2021; 77(6):2728-2738. DOI: 10.1111/jan.14802. View