Clinical complexity and hospital admissions in the December holiday period

• Published in: PloS one Vol. 15; no. 6; p. e0234112
• Main Authors: Lenti, Marco Vincenzo, Klersy, Catherine, Brera, Alice Silvia, Musella, Valeria, Benedetti, Irene, Padovini, Lucia, Ciola, Mariella, Croce, Gabriele, Ballesio, Alessia, Gorgone, Maria Fortunata, Bertolino, Giampiera, Di Sabatino, Antonio, Corazza, Gino Roberto
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 11-06-2020; Public Library of Science (PLoS)
• Subjects: Age; Biology and Life Sciences; Biometrics; Christmas; Cognitive ability; Complexity; Correlation analysis; Dementia; Demographic aspects; Deprivation; Enrollments; Epidemiology; Evaluation; Family physicians; Females; Forecasts and trends; Health aspects; Holidays; Holidays & special occasions; Hospital admission and discharge; Hospitalization; Hospitals; Income; Influence; Internal medicine; Longitudinal studies; Medicine; Medicine and Health Sciences; Mortality; New year; Patients; People and Places; Regression analysis; Resource allocation; Risk analysis; Risk factors; Social Sciences; Socioeconomics; Statistical analysis; Variables; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234112

Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period. This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed. Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.