Rate and risk factors of in-hospital and early postdischarge mortality in patients admitted to an internal medicine ward

• Published in: Clinical medicine (London, England) Vol. 23; no. 1; pp. 16 - 23
• Main Authors: Lenti, Marco Vincenzo, Croce, Gabriele, Brera, Alice Silvia, Ballesio, Alessia, Padovini, Lucia, Bertolino, Giampiera, Di Sabatino, Antonio, Klersy, Catherine, Corazza, Gino Roberto
• Format: Journal Article
• Language: English
• Published: London Royal College of Physicians 01-01-2023
• Subjects: Body mass index; Caregivers; Cognitive ability; Comorbidity; Consent; Deaths; Dementia; Disease; Emergency medical care; Family physicians; Frailty; Hospitals; Illnesses; Internal medicine; Length of stay; Malnutrition; Medical prognosis; Medicine; Mortality; Patients; Polypharmacy; Risk factors; Sociodemographics
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmed.2022-0176

Ageing, healthcare assessment, mortality predictors, multimorbidity DOI: 10.7861/clinmed.2022-0176 Introduction According to previous studies, hospital mortality in internal medicine wards ranged between 3% and 13% (Table 1),1-16 and this outcome is currently used as an indicator of quality of care and could play an important role in rethinking resource allocation and costs in healthcare systems.17,18 However, some authors have raised concerns that this parameter alone may not fully reflect care performance,19,20 and mortality in the early post-discharge period is also worth taking into consideration.21-23 This may be particularly relevant for internal medicine patients, who are increasingly burdened by multimorbidity, polypharmacy, frailty and dependency24 that may worsen over the course of the hospital stay and may be associated with both higher in-hospital and early post-discharge mortality.25 In fact, hospital-related adverse events, such as bed confinement, worsening cognitive function, drug reactions and hospital-acquired infections, may persist - and even worsen - shortly after a hospital stay.26,27 It is therefore crucial that all future studies consider post-discharge mortality and should not be based on retrospective analyses using electronic medical records, which may be biased by the intrinsic limitations of administrative data28,29 and may leave some clinical and non-clinical factors unconsidered or poorly described as possible determinants of the outcomes.24 Indeed, most of the available studies reported in Table 1 are rather heterogeneous, retrospective in nature, or lack a comprehensive description of potential factors associated with early mortality. Internal medicine is a medical specialty that is dedicated to the 'diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness'.32 In practice, adult patients who need to be admitted to hospital in order to receive a definitive diagnosis in the context of a complex clinical picture, or those who suffer from multiple diseases requiring coordinated care across multiple disciplines, are usually admitted to an internal medicine ward. At our hospital, after initial assessment performed in the emergency department, patients are allocated to the appropriate ward by the emergency physician according to the overall clinical picture and after discussion of the case with the admitting physician. According to the CIRS comorbidity and/or severity index, the majority of patients in all groups had a high disease burden, although this was even higher in those who died in hospital.