Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study

Angus J Turnbull; Eddie Donaghy; Lisa Salisbury; Pamela Ramsay; Janice Rattray; Timothy Walsh; Nazir Lone

doi:10.1016/j.bja.2020.09.035

Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study

Br J Anaesth. 2021 Feb;126(2):415-422. doi: 10.1016/j.bja.2020.09.035. Epub 2020 Oct 31.

Authors

Angus J Turnbull¹, Eddie Donaghy², Lisa Salisbury³, Pamela Ramsay⁴, Janice Rattray⁵, Timothy Walsh⁶, Nazir Lone²

Affiliations

¹ University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: angus.turnbull2@nhs.scot.
² University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK.
³ School of Health Sciences, Queen Margaret University Edinburgh, Musselburgh, UK.
⁴ School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
⁵ School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
⁶ University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK; MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.

Abstract

Background: Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness.

Methods: A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay.

Results: Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001).

Conclusions: This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.

Keywords: critical illness; drug interactions; emergency readmission; hospital readmission; intensive care; outcome; polypharmacy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Comorbidity
Critical Illness / therapy*
Databases, Factual
Emergency Service, Hospital*
Female
Humans
Male
Middle Aged
Patient Readmission*
Polypharmacy*
Registries
Risk Assessment
Risk Factors
Scotland
Sex Factors
Social Determinants of Health
Socioeconomic Factors
Time Factors
Young Adult