Background

Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required.

Objectives

To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission.

Methods

A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs <2 days) and readmission.

Results

There were 125 patients who met inclusion criteria (median age = 64 [interquartile range, 45–75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48–10.33 and aOR 3.24, 95% CI 1.05–10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05–6.57 and aOR 3.20, 95% CI 1.17–8.75, respectively).

Conclusion

This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.

中文翻译：

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与药物相关住院患者住院时间延长和再入院相关的临床因素：一项回顾性研究

背景

药物不良事件 (ADE) 仍然是住院的主要因素，导致住院时间长和再入院。有关与这些结果相关的特定药物和临床因素的信息是有限的。因此，需要更好地了解这些因素及其与 ADE 的关系。

目标

调查所涉及的药物、ADE 相关住院的临床表现，以及它们与住院时间和再入院时间的关系。

方法

对 2019 年 1 月至 2020 年 8 月在澳大利亚新南威尔士州一家大型三级转诊医院收治的患者进行了回顾性病历审查。使用澳大利亚精细诊断相关组 (AR-DRG) 代码确定 ADE：X40、X61、X62 和 X64。药物根据解剖治疗化学 (ATC) 分类系统进行分类，临床症状根据国际疾病分类 (ICD) 9-CM 进行分类。进行逻辑回归以评估药物和就诊类别与住院时间（≥2 天 vs <2 天）和再入院之间的关系。

结果

有 125 名患者符合纳入标准（中位年龄 = 64 [四分位距，45-75] 岁；53.6% 为男性）。抗血栓药、阿片类药物、抗抑郁药、抗精神病药、胰岛素和非甾体抗炎药是最受牵连的药理学类别。神经系统药物和跌倒与住院时间≥2 天相关（调整优势比 [aOR] 3.92, 95% 置信区间 [CI] 1.48–10.33 和 aOR 3.24, 95% CI 1.05–10.06，分别）。神经药物和神经和认知障碍与 90 天再入院的可能性增加相关（aOR 2.63, 95% CI 1.05-6.57 和 aOR 3.20, 95% CI 1.17-8.75）。

结论

这项研究将神经系统药物确定为因 ADE 住院的患者住院时间和再入院时间增加的高风险。这凸显了对这些药物进行明智处方和监测的必要性。