- Design
- Retrospective analysis of a national readmissions database
- Population
- 11.8 million hospital stays in adults ≥65, 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)
Using a US national readmissions database of 11.8 million hospital stays in adults aged 65 or more in 2019, this study compared the 0.9% who were transferred between hospitals with those who were not.
After adjustment for illness severity, readmission risk and other factors, transfer was associated with higher readmission (adjusted OR 1.09) and nearly double in-hospital mortality (adjusted OR 1.91, 95% CI 1.81 to 2.02). Thirty-day readmission was 29% higher.
Transferred patients are often sicker in ways a database cannot capture, so this does not mean transfer itself causes harm. It does argue for deliberate decisions and careful handover, especially when the transfer's purpose and the patient's wishes are unclear.
- Clarify the specific purpose of a transfer before arranging it for an older adult
- Discuss goals of care with the patient and family before transfer
- Send a complete medication list and functional baseline with every transfer
- Arrange early follow-up after discharge for patients who were transferred
Why it matters
Transfer is often treated as routine escalation, but it carries risk for older patients.
Don't overread it
Observational database study — residual confounding by illness severity is likely.
The statistics, in plain English
An OR of 1.91 means nearly double the odds of dying in hospital. Because sicker patients are more likely to be transferred, some of this gap reflects who was transferred rather than the transfer itself.
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