In the Literature

The Hospitalist. 2010 April;2010(04):

April 1, 2010|The Hospitalist

Charles Baillie, MD;Elizabeth Marandola, MSN, ARNP;Janelle Ocampo, PharmD, BCPS;Craig A. Umscheid, MD, MSCE;Section OF

In This Edition

Literature at a Glance

A guide to this month’s studies

Predictors of readmission for patients with CAP.
High-dose statins vs. lipid-lowering therapy combinations
Catheter retention and risks of reinfection in patients with coagulase-negative staph
Stenting vs. medical management of renal-artery stenosis
Dabigatran for VTE
Surgical mask vs. N95 respirator for influenza prevention
Hospitalization and the risk of long-term cognitive decline
Maturation of rapid-response teams and outcomes

Commonly Available Clinical Variables Predict 30-Day Readmissions for Community-Acquired Pneumonia

Clinical question: What are the risk factors for 30-day readmission in patients hospitalized for community-acquired pneumonia (CAP)?

Background: CAP is a common admission diagnosis associated with significant morbidity, mortality, and resource utilization. While prior data suggested that patients who survive a hospitalization for CAP are particularly vulnerable to readmission, few studies have examined the risk factors for readmission in this population.

Study design: Prospective, observational study.

Setting: A 400-bed teaching hospital in northern Spain.

Synopsis: From 2003 to 2005, this study consecutively enrolled 1,117 patients who were discharged after hospitalization for CAP. Eighty-one patients (7.2%) were readmitted within 30 days of discharge; 29 (35.8%) of these patients were rehospitalized for pneumonia-related causes.

Variables associated with pneumonia-related rehospitalization were treatment failure (HR 2.9; 95% CI, 1.2-6.8) and one or more instability factors at hospital discharge—for example, vital-sign abnormalities or inability to take food or medications by mouth (HR 2.8; 95% CI, 1.3-6.2). Variables associated with readmission unrelated to pneumonia were age greater than 65 years (HR 4.5; 95% CI, 1.4-14.7), Charlson comorbidity index greater than 2 (HR 1.9; 95% CI, 1.0-3.4), and decompensated comorbidities during index hospitalization.

Patients with at least two of the above risk factors were at a significantly higher risk for 30-day hospital readmission (HR 3.37; 95% CI, 2.08-5.46).

Bottom line: The risk factors for readmission after hospitalization for CAP differed between the groups with readmissions related to pneumonia versus other causes. Patients at high risk for readmission can be identified using easily available clinical variables.

Citation: Capelastegui A, España Yandiola PP, Quintana JM, et al. Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia. Chest. 2009;136(4): 1079-1085.

Clinical Shorts

ON-PUMP CABG SUPERIOR TO OFF-PUMP SURGERY

In a randomized study of 2,203 patients undergoing coronary-artery bypass surgery (CABG), the off-pump group had worse composite long-term outcomes compared with the on-pump group, without any significant difference in neuropsychiatric outcomes.

Citation: Shroyer AL, Grover FL, Hattler B, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19):1827-1837.

HIGH-FLOW OXYGEN AN EFFECTIVE TREATMENT FOR CLUSTER HEADACHES

In a double-blind, placebo-controlled, crossover trial, self-administered high-flow oxygen after onset of a cluster headache led to a higher rate of symptom resolution (78% vs. 20%) at 15 minutes, compared with placebo.

Citation: Cohen AS, Burns B, Goadsby PJ. High-flow oxygen for treatment of cluster headache: a randomized trial. JAMA. 2009;302(22):2451-2457.

Combinations of Lipid-Lowering Agents No More Effective than High-Dose Statin Monotherapy

Clinical question: Is high-dose statin monotherapy better than combinations of lipid-lowering agents for dyslipidemia in adults at high risk for coronary artery disease?

Background: While current guidelines support the benefits of aggressive lipid targets, there is little to guide physicians as to the optimal strategy for attaining target lipid levels.

Study design: Systematic review.

Setting: North America, Europe, and Asia.

Synopsis: Very-low-strength evidence showed that statin-ezetimibe (two trials; N=439) and statin-fibrate (one trial; N=166) combinations did not reduce mortality more than high-dose statin monotherapy. No trial data were found comparing the effect of these two strategies on secondary endpoints, including myocardial infarction, stroke, or revascularization.