- Design
- Retrospective analysis of a national readmissions database
- Population
- About 11.8 million hospitalised adults aged ≥65 in the US, 2019
- Primary outcome
- Readmission and in-hospital mortality
- Effect
- Mortality AOR 1.91 (1.81 to 2.02); readmission AOR 1.09 (1.01 to 1.18)
A cross-sectional study in the Journal of the American Geriatrics Society, published on 11 October, used a US national readmissions database covering about 11.8 million hospitalised adults aged 65 and over in 2019, of whom 0.9% were transferred between hospitals.
After adjustment for mortality risk, readmission risk, admitting service, insurer and procedures, transfer was associated with higher in-hospital mortality (adjusted OR 1.91, 95% CI 1.81 to 2.02) and readmission (adjusted OR 1.09; 1.29 for 30-day readmission in a sensitivity analysis).
The obvious explanation — that sicker patients get transferred — cannot be fully adjusted away in administrative data. Still, transfer itself carries risks for older people: handover gaps, medication changes, delirium and disorientation. The study supports careful decisions about who benefits from transfer and attention to handover when it happens.
- Before transferring an older patient, confirm the specific benefit and discuss goals of care.
- Send a complete medication list and the baseline cognitive and functional status with every transfer.
- Screen transferred older patients for delirium on arrival.
- Plan discharge follow-up carefully after a transfer; readmission risk was higher.
Why it matters
Transfers are often decided quickly, yet they were linked to almost twice the odds of in-hospital death.
Don't overread it
Observational administrative data; sicker patients are more likely to be transferred, so transfer may not cause the harm.
The statistics, in plain English
An adjusted odds ratio of 1.91 means nearly double the odds of death, but adjustment can only account for what the database records. Severity not captured by billing codes may explain much of the difference.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for geriatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free