Are elderly patients with obstructive airway disease being prematurely discharged?

Despite the temporal trend toward decreasing length of hospital stay for al l medical conditions in North America, the effect of different lengths of h ospitalization on short-term outcomes such as readmission or mortality has not been well studied. However, there is growing concern that very short st ays in hospital may result in premature discharges, which may lead to worse outcomes for patients. We conducted a population-based study of elderly pa tients with obstructive airway disease in Ontario, Canada to test the hypot hesis that very short initial hospital stays increase the short-term risk f or readmission and mortality. Using a cohort of 32,384 elderly patients 65 yr of age or older, we compared 15-d rates of readmission and mortality amo ng patients with different lengths of stay. Although patients with hospital stays of less than 4 d were younger and had fewer comorbidities, they were 39% (95% confidence interval [CI], 20% to 61%) more likely to be readmitte d and 45% (95% CI, 9% to 92%) more likely to die within 15 d postdischarge compared with those who stayed 4 to 6 d. The risk was highest among patient s whose stay was less than or equal to 1 hospital day; they had a 69% (95% CI, 32% to 117%) excess risk of readmission and a 2.08 (95% CI, 1.23 to 3.4 5) -fold increase in mortality compared with those who stayed in hospital f or 2 d. This suggests that some elderly patients with obstructive airway di sease may be being prematurely discharged.