Among hospitalized patients with community acquired pneumonia (CAP), the administration of in-hospital influenza vaccination may be underutilized, and secondary infections due to pneumonia can result in readmissions, according to a study being presented at the CHEST Annual Meeting 2019.
The retrospective study assessed information from the Agency for Healthcare Research and Quality-Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014. They included adults with a principal diagnosis of CAP and a procedure diagnosis of influenza vaccination. A total of 825,906 hospital admissions were identified, 1.91% (n=14,047) of which received in-hospital influenza vaccination.
Researchers paired CAP patients who received a vaccine (n=9,777) with those who did not (n=9,777) to adjust for confounders. The overall 30-day readmission rate (primary endpoint) was 11.9%, and the most common reason for readmission was pneumonia (98.1%). Readmission resulted in significantly higher mortality compared with the index admission (7.69% vs. 3.32%; P<0.001). A total of 489,247 hospital days were associated with readmission, and the total healthcare burden was $1 billion in costs and $3.67 billion in charges.
The following factors were associated with a high risk of readmission: in-hospital vaccination (hazard ratio = 0.821; 95% confidence interval, 0.69-0.98; P<0.02), advanced age, Medicare insurance, higher Charlson Comorbidity Index score, atrial fibrillation, acute respiratory failure, and in-hospital oxygen use.
“Although the beneficial effects of influenza vaccination are well described, this is regarded as a primary care-driven service,” the authors noted, despite the fact that it has “significant implications on hospital readmission and morality.”
- Ho KS, Sheehan J, Wu L, et al. Missed opportunity for in-hospital vaccination? Influenza vaccination reduces 30-day readmission among patients with community acquired pneumonia: a propensity score match analysis. Presented at the CHEST Annual Meeting 2019. October 19-23, 2019; New Orleans, Louisiana.