Thirty-day hospital readmission and its determinants among patients with severe community-acquired pneumonia: a prospective cross-sectional study in Northwest Ethiopia

Abstract

Hospital readmissions are a frequent complication of community-acquired pneumonia (CAP), resulting in significant clinical and economic burdens. In Ethiopia, data on 30-day readmissions and related factors are lacking. This study aimed to determine the prevalence and factors associated with 30-day all-cause readmission after severe CAP hospitalization at the University of Gondar Comprehensive Specialized Hospital (UOGCSH). A cross-sectional study was conducted From July 1, 2023, to June 30, 2024, among 177 patients with severe CAP who had been discharged alive from the UOGCSH. Patients were selected using a consecutive sampling technique, and severe CAP was defined according to the Infectious Diseases Society of America (IDSA) criteria. Multivariable binary logistic regression was used to identify factors associated with 30-day all-cause hospital readmission, and the results were reported with a 95% CI. Statistical significance was set at p < 0.05. The prevalence of 30-day all-cause hospital readmission was 29.9% (95% CI: 23.3 to 37.3); of those, the majority (71.7%) were readmitted within two weeks. Chronic obstructive pulmonary disease (AOR = 4.51; 95% CI: 1.19 - 17.15), fever (AOR = 3.12; 95% CI: 1.26 - 7.73), admission with ≥3 comorbidities (AOR = 2.68; 95% CI: 1.11 - 6.50), presence of ≥ 1 clinical instability factor at discharge (AOR = 2.54; 95% CI: 1.06 - 6.13), complications of severe CAP, including parapneumonic effusion (AOR = 3.13; 95% CI: 1.26 - 7.77) and respiratory failure (AOR = 4.36; 95% CI: 1.74 - 10.93) were significantly associated with 30-day all-cause hospital readmission. More than a quarter of patients hospitalized for severe CAP were readmitted within 30 days, and nearly two-thirds were readmitted within two weeks. Patients with severe CAP who were admitted with pulmonary disease, multiple comorbidities, discharged with clinical instability, and developed severe CAP complications were more likely to be readmitted to the hospital. Thus, the provision of optimized in-hospital care, clear discharge planning, post-discharge follow-up, patient education, medication reconciliation, and vaccination can reduce readmission rates.