title: The crucial factor of hospital readmissions: a retrospective cohort study of patients evaluated in the emergency department and admitted to the department of medicine of a general hospital in Italy.
abstract: BACKGROUND
  Early hospital readmissions, defined as rehospitalization within 30 days from a previous discharge, represent an economic and social burden for public health management. As data about early readmission in Italy are scarce, we aimed to relate the phenomenon of 30-day readmission to factors identified at the time of emergency department (ED) visits in subjects admitted to medical wards of a general hospital in Italy.
  
  
  METHODS
  We performed a retrospective 30-month observational study, evaluating all patients admitted to the Department of Medicine of the Hospital of Ferrara, Italy. Our study compared early and late readmission: patients were evaluated on the basis of the ED admission diagnosis and classified differently on the basis of a concordant or discordant readmission diagnosis in respect to the diagnosis of a first hospitalization.
  
  
  RESULTS
  Out of 13,237 patients admitted during the study period, 3,631 (27.4%) were readmitted; of those, 656 were 30-day rehospitalizations (5% of total admissions). Early rehospitalization occurred 12 days (median) later than previous discharge. The most frequent causes of rehospitalization were cardiovascular disease (CVD) in 29.3% and pulmonary disease (PD) in 29.7% of cases. Patients admitted with the same diagnosis were younger, had lower length of stay (LOS) and higher prevalence of CVD, PD and cancer. Age, CVD and PD were independently associated with 30-day readmission with concordant diagnosis and kidney disease with 30-day rehospitalization with a discordant diagnosis.
  
  
  CONCLUSIONS
  Comorbid patients are at higher risk for 30-day readmission. Reduction of LOS, especially in elderly subjects, could increase early rehospitalization rates.
authors.affiliation: Clinica Medica, Department of Medical Science, University of Ferrara, 44124, Cona Ferrara, Italy. fbbfba@unife.it.|Department of Medicine, Azienda Ospedaliera-Universitaria (AOU) of Ferrara, 44124, Cona Ferrara, Italy. fbbfba@unife.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.affiliation: Clinica Medica, Department of Medical Science, University of Ferrara, 44124, Cona Ferrara, Italy. arrigo.boccafogli@unife.it.|Department of Medicine, Azienda Ospedaliera-Universitaria (AOU) of Ferrara, 44124, Cona Ferrara, Italy. arrigo.boccafogli@unife.it.
authors.forename: Arrigo
authors.initials: A
authors.lastname: Boccafogli
authors.affiliation: Clinica Medica, Department of Medical Science, University of Ferrara, 44124, Cona Ferrara, Italy. degiorgialfredo@libero.it.|Department of Medicine, Azienda Ospedaliera-Universitaria (AOU) of Ferrara, 44124, Cona Ferrara, Italy. degiorgialfredo@libero.it.
authors.forename: Alfredo
authors.initials: A
authors.lastname: De Giorgi
authors.affiliation: Clinica Medica, Department of Medical Science, University of Ferrara, 44124, Cona Ferrara, Italy. marco.pala@unife.it.|Department of Medicine, Azienda Ospedaliera-Universitaria (AOU) of Ferrara, 44124, Cona Ferrara, Italy. marco.pala@unife.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Pala
authors.affiliation: 2nd Unit of Internal Medicine, Department of Medicine, AOU of Ferrara, Ferrara, Italy. raffaella.salmi@ospfe.it.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Salmi
authors.affiliation: Emergency Department, AOU of Ferrara, Ferrara, Italy. r.melandri@ospfe.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Melandri
authors.affiliation: 1st Unit of Internal Medicine, Department of Medicine, AOU of Ferrara, Ferrara, Italy. m.gallerani@ospfe.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallerani
authors.affiliation: Medical Director, AOU of Ferrara, Ferrara, Italy. a.gardini@ospfe.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gardini
authors.affiliation: General Manager, AOU of Ferrara, Ferrara, Italy. g.rinaldi@ospfe.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rinaldi
authors.affiliation: Clinica Medica, Department of Medical Science, University of Ferrara, 44124, Cona Ferrara, Italy. roberto.manfredini@unife.it.|Department of Medicine, Azienda Ospedaliera-Universitaria (AOU) of Ferrara, 44124, Cona Ferrara, Italy. roberto.manfredini@unife.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies