Clinical characteristics and risk factors of preventable hospital readmissions within 30 days.

Knowledge regarding preventable hospital readmissions is scarce. Our aim was to compare the clinical characteristics of potentially preventable readmissions (PPRs) with non-PPRs. Additionally, we aimed to identify risk factors for PPRs. Our study included readmissions within 30 days after discharge from 1 of 7 hospital departments. Preventability was assessed by multidisciplinary meetings. Characteristics of the readmissions were collected and 23 risk factors were analyzed. Of the 1120 readmissions, 125 (11%) were PPRs. PPRs occurred equally among different departments (p = 0.21). 29.6% of PPRs were readmitted by a practitioner of a different medical specialty than the initial admission (IA) specialist. The PPR group had more readmissions within 7 days (PPR 54% vs. non-PPR 44%, p = 0.03). The median LOS was 1 day longer for PPRs (p = 0.16). Factors associated with PPR were higher age (p = 0.004), higher socio-economic status (p = 0.049), fewer prior hospital admissions (p = 0.004), and no outpatient visit prior to readmission (p = 0.025). This study found that PPRs can occur at any department in the hospital. There is not a single type of patient that can easily be pinpointed to be at risk of a PPR, probably due to the multifactorial nature of PPRs.

Biochemical cardiovascular risk factors after hypertensive pregnancy disorders: a systematic review and meta-analysis.

The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inception to February 28, 2011) supplemented by manual searches of bibliographies. Included were cohort studies and case-control studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders compared with women with previous normotensive pregnancies. Of 2573 studies reviewed for eligibility, quality, and data extraction, 22 were included in the review, of which 15 could be meta-analyzed. The pooled mean differences for the outcomes of interest were 0.17 mmol/L (95% confidence interval [CI], 0.08-0.25 mmol/L) for glucose (10 studies), 3.46 mU/mL (95% CI, 2.34-4.58 mU/mL) for insulin (5 studies), 0.13 mmol/L (95% CI, 0.05-0.21) for triglycerides (10 studies), 0.22 mmol/L (95% CI, 0.11-0.33 mmol/L) for total cholesterol (11 studies), -0.11 mmol/L (95% CI, -0.18 to -0.04 mmol/L) for high-density lipoprotein cholesterol (10 studies), and 0.21 mmol/L (95% CI, 0.10-0.32) for low-density lipoprotein cholesterol (9 studies), all in the disadvantage in women with previous hypertensive pregnancy disorders. Analyses for preeclampsia alone showed similar results. CONTINUED LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to assess the long-term cardiovascular consequences after hypertensive pregnancy disorders, evaluate and interpret the evidence regarding biochemical cardiovascular risk factor assessment after pregnancy, and counsel women with a history of hypertensive pregnancy disorders as to the effectiveness of cardiovascular risk factor assessment in the primary prevention of cardiovascular disease. CONCLUSIONS: Women with previous hypertensive pregnancy disorders have higher glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels measured after pregnancy compared with women with previous normotensive pregnancies. These biochemical cardiovascular risk factors may identify women who will benefit from primary prevention of cardiovascular disease. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians.