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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Unplanned readmissions following discharge are burdensome to patients, family, and health care systems. This study aimed to investigate whether uncontrolled pain on discharge-day increased the likelihood of unplanned readmissions in a surgical population at a tertiary cancer hospital.
Methods This quality improvement retrospective study analyzed adult (age ≥ 18 years) inpatient data including pain assessments during hospitalization and discharge over a 12-month period, yielding a total of 249,458 inpatient hospital days and 26,677 hospital discharges (alive), of this 7993 were surgical discharges. The primary outcome of interest was 30-day unplanned readmissions for any reason. We defined uncontrolled-pain on the day of discharge in two ways ─ a) documentation of ≥3 consecutive severe-pain scores (≥7 on 0-10 scale) (severe-pain-3C); and b) severe-pain documented as the last score prior to discharge (≥7 on 0-10 scale) (severe-pain-L).
Results On discharge-day, the frequency of surgical patients discharged with uncontrolled-pain were 3.2% and 3.5% for severe-pain-3c and severe-pain-L, respectively. Figure 1 demonstrates monthly trends for uncontrolled pain during hospitalization and discharge-day, which remained stable. The overall 30-day hospital readmission rate for surgical patients was 9.5% (figure 1). The odds-ratio for 30-day hospital readmission with uncontrolled pain on discharge was 2.69 (1.99 - 3.63), P< 0.0001 for severe-pain-3C and 2.95 (2.182-3.98), P < 0.0001 for severe-pain-L (figure 2) and adjusted odds ratio (figure 3).
Trend of Severe Pain Measured on Hospital Discharge Day – Surgical Services
Odds ratio (95% CI) of 30-Day hospital readmission with uncontrolled pain on discharge - Surgical Services
Adjusted Odds Ration of All-cause 30-Day Unplanned Hospital Readmission – Surgical Services
Conclusions Uncontrolled pain on discharge was shown to be positively associated with 30-day all-cause readmission. These findings support the need for further research, including the development of targeted discharge planning interventions that prioritize timely follow-up and management of post-discharge pain