title: Lower handgrip strength at discharge from acute care hospitals is associated with 30-day readmission: A prospective cohort study.
abstract: Malnutrition at admission, using various parameters, is associated with 30-day readmission. However, the association between 30-day readmission and nutritional parameters at discharge has not been studied.
  
  
  
  From a large cohort study (n = 1022), 413 patients with a length of stay of ≥7 days who had information on readmission and discharge location were included into the analysis. Their nutritional status at discharge was assessed by subjective global assessment, body mass index, albumin, nutritional risk index and handgrip strength. Data on demography, diagnoses and Charlson comorbidity index (CCI) were also collected. Missing data was handled using multiple imputations by chained equations. Association of nutrition related measures with 30 day readmission was tested in logistic regression models.
  
  
  
  Of the 413 patients, 86 (20.8%) were readmitted within 30 days. The proportion of readmitted patients was higher for medical (42.2%) versus surgical patients (25.6%) (p = 0.005) and disease severity was higher in the readmission group with (median (q1, q3) CCI of 3 (2, 6) versus 2(1, 4) for no readmission (p = 0.009). Among the nutritional parameters assessed at discharge, only handgrip strength was significantly associated with 30-day readmission both in unadjusted and adjusted models. Stronger handgrip was associated with decreased chances for readmission where adjusted OR (95% CI) per unit increase were 0.95 (0.92, 0.99). Handgrip strength was not associated with disease severity assessed by CCI (p = 0.14) but was significantly associated with SGA (SGA A and B significantly different from SGA C: both p-values <0.001) after adjusting for age and gender.
  
  
  
  Lower handgrip at discharge was associated with 30-day readmission. This assessment may be useful to detect patients at risk of readmission to better individualize discharge planning including nutrition care.
authors.affiliation: Department of Medicine, University Health Network, University of Toronto, Ontario, Canada. Electronic address: Johane.allard@uhn.on.ca.
authors.forename: Johane P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Keller
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Teterina
authors.affiliation: Department of Medicine, St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Khursheed N
authors.initials: KN
authors.lastname: Jeejeebhoy
authors.affiliation: Clinical Nutrition Department, Réseau de Santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Laporte
authors.affiliation: Department of Medicine, St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Helene
authors.initials: H
authors.lastname: Payette
authors.affiliation: Jewish General Hospital, Montréal, Québec, Canada.
authors.forename: Paule
authors.initials: P
authors.lastname: Bernier
authors.affiliation: Canadian Nutrition Society, Ottawa, Ontario, Canada.
authors.forename: Bridget
authors.initials: B
authors.lastname: Davidson
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D018737:Hand Strength; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin
keywords: 30-Day readmission; Handgrip strength; Hospital malnutrition; Muscle function