title: Association between frailty and 30-day outcomes after discharge from hospital.
abstract: BACKGROUND
  Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards.
  
  
  METHODS
  We prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge.
  
  
  RESULTS
  Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12-4.24).
  
  
  CONCLUSIONS
  Frailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards.
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Sharry
authors.initials: S
authors.lastname: Kahlon
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Jenelle
authors.initials: J
authors.lastname: Pederson
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Sara
authors.initials: S
authors.lastname: Belga
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Darren
authors.initials: D
authors.lastname: Lau
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Miriam
authors.initials: M
authors.lastname: Fradette
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Debbie
authors.initials: D
authors.lastname: Boyko
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Curtis
authors.initials: C
authors.lastname: Johnston
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
authors.affiliation: Division of General Internal Medicine (Kahlon, Pederson, Majumdar, Belga, Lau, Padwal, McAlister); Patient Health Outcomes Research and Clinical Effectiveness Unit (Bakal, McAlister); Epidemiology Coordinating and Research (EPICORE) Centre (Fradette, Boyko, McAlister), University of Alberta; Department of Medicine (Johnston), Royal Alexandra Hospital, Edmonton, Alta. finlay.mcalister@ualberta.ca.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors