Routine flu vaccination for adults hospitalized with pneumonia can reduce readmissions, mortality
NEW ORLEANS — In-hospital influenza vaccination may reduce 30-day readmissions, mortality, morbidity and health care resource utilization in adults with community-acquired pneumonia.
In a study presented at the CHEST Annual Meeting, among 825,906 hospital admissions with a primary diagnosis of community-acquired pneumonia in 2014, only 1.91% of patients received an influenza vaccination during the index hospitalization.
“We were surprised by the fact that only 1.9% of patients received an influenza vaccine during their hospital admission. Essentially, we are ‘missing out’ on a golden opportunity to address this issue,” Kam Sing Ho, MD, from Mount Sinai St. Luke’s and Mount Sinai West, told Healio Pulmonology.
Overall, 11.9% of the patients with community-acquired pneumonia were readmitted to the hospital within 30 days, with pneumonia noted as the cause of readmission in 98%, according to the new data.
Risk for mortality was 7.69% among patients readmitted within 30 days, compared with 3.32% among the index admissions.
In 2014, 489,247 hospital days were associated with readmissions, according to the results. The total health care in-hospital economic burden associated with readmissions was $1 billion in costs and $3.67 billion in charges, according to the results.
In-hospital influenza vaccination was associated with a 6.5% reduction in readmissions, according to a press release.
Independent risk factors for readmission included older age, Medicare insurance, higher Charlson comorbidity score, atrial fibrillation, acute respiratory failure and in-hospital oxygen use.
The retrospective study focused on 2014 data from the AHRQ-HCUP Nationwide Readmission Database for adults with a principal diagnosis of community-acquired pneumonia and a procedure diagnosis of influenza vaccination. The researchers used propensity score matching to pair 9,777 patients with pneumonia who received an influenza vaccination with 9,777 patients with pneumonia who did not receive a vaccination.
“Peng-jun Lu et al have previously found that inpatient influenza vaccination has a benefit for adults readmitted to the hospital with high-risk conditions. In our study, we showed that this benefit may be extended to the general population,” Ho said.
However, challenges remain when it comes to implementing vaccination.
“Some of the challenges of implementing vaccination during the hospital may be (1) pressure from hospital administration to discharge in a time-manner (ie, ‘the discharge before noon’ initiative), (2) clinical condition of the patient (ie, those who are very ill may not be in a state to receive vaccine), (3) patient beliefs or refusal of vaccination, and (4) overreliance on outpatient providers to address health prevention.
“As shown in the national database, the average adult was admitted for 5 to 6 days for pneumonia, which provides ample opportunity for physicians to discuss the benefit of vaccination. Also, patients are discharged at ‘baseline’ (ie, stable conditions), at which vaccination may be suitable. Lastly, previous studies have already shown that preventive health has a role in the hospital,” Ho said.
Ho and colleagues plan to look at implementing inpatient vaccination his hospital and the effect on local readmission rates, utilization of health resources and mortality. – by Katie Kalvaitis
Ho KS, et al. Poster E1008. Presented at: CHEST Annual Meeting; Oct. 19-23, 2019; New Orleans.
Disclosure: Ho reports no relevant financial disclosures.