Interhospital Transfer Associated With Higher Readmission and Inpatient Mortality in Older Adults

Interhospital transfer provides access to specialty care but may carry risks for older patients. Researchers used the 2019 National Readmissions Database to examine associations between transfer, acute-care readmission, and inpatient mortality among adults aged 65 or older. The observational analysis included a weighted population of 11,836,556 older adults, of whom 0.9% underwent transfer, and used adjusted logistic regression accounting for hospital clustering and regional stratification.

Transfer was associated with higher adjusted odds of readmission (adjusted odds ratio [AOR] 1.09, 95% CI 1.01–1.18) and inpatient mortality (AOR 1.91, 95% CI 1.81–2.02). In a sensitivity analysis specifically examining 30-day readmission, transferred patients had 29% higher adjusted odds than those not transferred (AOR 1.29, 95% CI 1.19–1.40). Adjustment included mortality risk, readmission risk, admitting service, insurer, and procedure characteristics.

These results support closer examination of transfer processes for older adults but do not establish causality or show that avoiding transfer improves outcomes. Residual confounding may remain despite adjustment. Only the abstract was available; it does not report absolute event rates or specify the primary readmission window. Further research is needed to identify underlying drivers and practices that could improve transfer outcomes.