Lower handgrip strength at discharge from acute care hospitals is associated with 30-day readmission: A prospective cohort study

Johane P Allard; Heather Keller; Anastasia Teterina; Khursheed N Jeejeebhoy; Manon Laporte; Donald R Duerksen; Leah Gramlich; Helene Payette; Paule Bernier; Bridget Davidson; Wendy Lou

doi:10.1016/j.clnu.2016.04.008

Lower handgrip strength at discharge from acute care hospitals is associated with 30-day readmission: A prospective cohort study

Clin Nutr. 2016 Dec;35(6):1535-1542. doi: 10.1016/j.clnu.2016.04.008. Epub 2016 Apr 13.

Authors

Affiliations

¹ Department of Medicine, University Health Network, University of Toronto, Ontario, Canada. Electronic address: Johane.allard@uhn.on.ca.
² Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
³ Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
⁴ Department of Medicine, St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Clinical Nutrition Department, Réseau de Santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada.
⁶ Department of Medicine, St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
⁸ Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
⁹ Jewish General Hospital, Montréal, Québec, Canada.
¹⁰ Canadian Nutrition Society, Ottawa, Ontario, Canada.
¹¹ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 27155939
DOI: 10.1016/j.clnu.2016.04.008

Abstract

Background: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Keywords: 30-Day readmission; Handgrip strength; Hospital malnutrition; Muscle function.

Publication types

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

MeSH terms

Aged
Body Mass Index
Female
Hand Strength*
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Nutrition Assessment
Nutritional Status
Patient Discharge*
Patient Readmission*
Prospective Studies
Risk Factors
Serum Albumin / metabolism

Substances

Serum Albumin