Variability in Post-Discharge Mortality Rates and Predictors over Time: Data from a Five-Year Ward-Wide Study

TL;DR

This study examines post-discharge mortality rates and their predictors over five years for patients in Internal Medicine Departments, finding that many may benefit from early palliative care.

Contribution

The study identifies distinct predictors for early, intermediate, and late post-discharge mortality in multi-morbid patients.

Findings

Post-discharge mortality was 57% over five years, with an early peak of 32% in the first year.

Cancer, neurological disorders, and respiratory failure were linked to early and intermediate mortality.

Cardiovascular and gastrointestinal disorders were associated with late mortality.

Abstract

Background/Objectives: Patients with complex chronic disorders constitute a growing share of the general population and are frequently hospitalised for acute care in Internal Medicine Departments. Little is known about long-term rates and predictors of post-discharge mortality, possibly contributing to suboptimal and discontinuous care, including delayed referral to palliative programmes. Methods: To assess the long-term post-discharge mortality of patients admitted to Internal Medicine Departments and its predictors, we analysed a cohort of old, multi-morbid subjects, corresponding to the whole population of patients admitted to an Internal Medicine Department over 12 months (February 2016–March 2017). Public health registries were interrogated to assess the five-year mortality (up to 2022) of patients discharged alive. Results: Post-discharge mortality was 57% at follow-up end, with an early peak rate of 32% at year 1, a 10–14% intermediate rate at years 2–4, and a 7% late rate, approaching expected figures in the general population. Cancer, neurological and liver disorders, and respiratory failure were significantly associated with early and intermediate mortality, while renal disorders, dependence for daily activities, and immunodepression were selectively relevant for death in the first year. Cardiovascular and upper gastrointestinal disorders were associated with late mortality. Surrogate measures of frailty, intensity of care, and patient complexity were also able to predict early-, intermediate-, and late-mortality risk. Conclusions: A relevant fraction of patients hospitalised in Internal Medicine Departments might require palliative care. Dissecting the differential contribution of clinical and healthcare-associated variables for short, medium-, and long-term mortality might facilitate patient management and identify subjects in need of early or simultaneous palliative care.

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