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Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purposes

We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality.

Methods

Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders.

Results

The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p < 0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01–1.08; p = 0.02), comorbidities (OR 1.18; 95% CI 1.12–1.24; p < 0.0001), and AEs (OR 6.80; 95% CI 3.58–12.9; p < 0.0001) were significantly associated with in-hospital mortality.

Conclusions

Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk.

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Acknowledgments

We thank Professor Farncesco Violi, President of the Italian Society of Internal Medicine, for his help and encouragement. We are grateful to Judith Baggott for editorial assistance.

Financial disclosure

Carlotta Franchi holds a fellowship granted by Rotary Clubs Milano Naviglio Grande San Carlo, Milano Scala and Inner Wheel Milano San Carlo.

Conflict of interest

All the authors declare that no conflict of interest exist. All the authors state that they have a full control of data and that they agree to allow the journal to review their data if requested.

Funding sources

Nothing.

Author information

Authors and Affiliations

  1. Laboratory for Quality Assessment of Geriatric Therapies and Services, “Mario Negri” Institute for Pharmacological Research, via Giuseppe La Masa, 19, 20156, Milan, Italy

    Alessandro Nobili, Luca Pasina, Carlotta Franchi & Luigi De Vittorio

  2. Laboratory of Geriatric Neuropsychiatry, “Mario Negri” Institute for Pharmacological Research, via Giuseppe La Masa, 19, 20156, Milan, Italy

    Mauro Tettamanti

  3. Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy

    Giuseppe Licata & Salvatore Corrao

  4. Medicina Interna, IRCCS Policlinico San Donato, University of Milano, Milan, Italy

    Francesco Salerno

  5. Department of Medical and Surgery Sciences, University of Brescia Geriatric Ward, Spedali Civili, Brescia, Italy

    Alessandra Marengoni

  6. Department of Internal Medicine, University of Perugia, Perugia, Italy

    Alfonso Iorio & Maura Marcucci

  7. Scientific Direction, IRCCS Cà Granda Foundation Maggiore Policlinico Hospital, Milan, Italy

    Pier Mannuccio Mannucci

Authors
  1. Alessandro Nobili
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  2. Giuseppe Licata
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  3. Francesco Salerno
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  4. Luca Pasina
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  5. Mauro Tettamanti
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  6. Carlotta Franchi
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  7. Luigi De Vittorio
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  8. Alessandra Marengoni
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  9. Salvatore Corrao
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  10. Alfonso Iorio
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  11. Maura Marcucci
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  12. Pier Mannuccio Mannucci
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Consortia

On behalf of SIMI Investigators

Corresponding author

Correspondence to Alessandro Nobili.

Additional information

SIMI, Italian Society of Internal Medicine. Participating hospitals and coauthors are listed in the Acknowledgements.

Appendix

Appendix

REPOSI collaborators and participating units

The following hospital and investigators contributed to this study: Pier Mannuccio Mannucci, Alberto Tedeschi, Raffaella Rossio (Medicina Interna 2, Fondazione IRCCS Ospedale Maggiore, Milano); Guido Moreo, Barbara Ferrari (Medicina Interna 3, Fondazione IRCCS Ospedale Maggiore, Milano); Cesare Masala, Antonio Mammarella, Valeria Raparelli (Medicina Interna, Università La Sapienza, Roma); Nicola Carulli, Stefania Rondinella, Iolanda Giannico (Medicina Metabolica, Università di Modena e Reggio Emilia); Leonardo Rasciti, Silvia Gualandi (Medicina Interna, Policlinico S. Orsola Malpighi, Bologna); Valter Monzani, Valeria Savojardo (Medicina d’Urgenza, IRCCS Fondazione Ospedale Maggiore, Milano); Maria Domenica Cappellini, Giovanna Fabio, Flavio Cantoni (Medicina Interna 1A, Fondazione IRCCS Ospedale Maggiore, Milano); Franco Dallegri, Luciano Ottonello, Alessandra Quercioli, Alessandra Barreca (Medicina Interna 1, Università di Genova); Riccardo Utili, Emanuele Durante-Mangoni, Daniela Pinto (Medicina Interna, Seconda Università di Napoli); Roberto Manfredini, Elena Incasa, Emanuela Rizzioli (Medicina Interna, Azienda USL, Ferrara); Massimo Vanoli, Gianluca Casella (Medicina Interna, Ospedale di Lecco, Merate); Giuseppe Musca, Olga Cuccurullo (Medicina Interna, P.O. Cetraro, ASP Cosenza); Laura Gasbarrone, Giuseppe Famularo, Maria Rosaria Sajeva (Medicina Interna, Ospedale San Camillo Forlanini, Roma); Antonio Picardi, Dritan Hila (Medicina Clinica-Epatologia, Università Campus Bio-Medico, Roma); Renzo Rozzini, Alessandro Giordano (Fondazione Poliambulanza, Brescia); Andrea Sacco, Antonio Bonelli, Gaetano Dentamaro (Medicina, Ospedale Madonna delle Grazie, Matera); Francesco Salerno, Valentina Monti, Massimo Cazzaniga (Medicina Interna, IRCCS Policlinico San Donato, Università di Milano); Ingrid Nielsen, Piergiorgio Gaudenzi, Lisa Giusto (Medicina ad Alta Rotazione, Azienda Ospedaliera Universitaria, Ferrara); Enrico Agabiti Rosei, Damiano Rizzoni, Luana Castoldi (Clinica Medica, Università di Brescia); Daniela Mari, Giuliana Micale (Medicina Generale ad indirizzo Geriatrico, IRCCS Istituto Auxologico Italiano, Milano); Emanuele Altomare, Gaetano Serviddio, Santina Salvatore (Medicina Interna, Università di Foggia); Carlo Longhini, Cristian Molino (Clinica Medica, Azienda Mista Ospedaliera Universitaria Sant’Anna, Ferrara); Giuseppe Delitalia, Silvia Deidda, Luciana Maria Cuccuru (Clinica Medica, Azienda Mista Ospedaliera Universitaria, Sassari); Giampiero Benetti, Michela Quagliolo, Giuseppe Riccardo Centenaro (Medicina 1, Ospedale di Melegnano, Vizzolo Predabissi, Milano); Alberto Auteri, Anna Laura Pasqui, Luca Puccetti (Medicina Interna, Azienda Ospedaliera Universitaria Le Scotte, Siena); Carlo Balduini, Giampiera Bertolino, Piergiorgio Cavallo (Dipartimento di Medicina Interna, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia); Esio Ronchi, Daniele Bertolini, Nicola Lucio Liberato (Medicina Interna, Ospedale Carlo Mira, Casorate Primo, Pavia); Antonio Perciccante, Alessia Coralli (Medicina, Ospedale San Giovanni-Decollato-Andisilla, Civita Castellana); Luigi Anastasio, Leonardo Bertucci (Medicina Generale, Ospedale Civile Serra San Bruno); Giancarlo Agnelli, Ana Macura, Alfonso Iorio, Maura Marcucci (Medicina Interna e Cardiovascolare, Ospedale Santa Maria della Misericordia, Università di Perugia); Cosimo Morabito, Roberto Fava (Medicina, Ospedale Scillesi d’America, Scilla); Giuseppe Licata, Antonino Tuttolomondo, Riccardo Di Sciacca (Medicina Interna e Cardioangiologia, Università degli Studi di Palermo); Luisa Macchini, Anna Realdi (Clinica Medica 4, Università di Padova); Luigi Cricco, Alessandra Fiorentini, Cristina Tofi (Geriatria, Ospedale di Montefiascone); Carlo Cagnoni, Antonio Manucra (UO Medicina e Primo Soccorso, Ospedale di Bobbio, Azienda USL di Piacenza); Giuseppe Romanelli, Alessandra Marengoni, Francesca Bonometti (UO Geriatria, Spedali Civili di Brescia); Michele Cortellaro, Maria Rachele Meroni, Marina Magenta (Medicina 3, Ospedale Luigi Sacco, Università di Milano); Carlo Vergani, Dionigi Paolo Rossi (Geriatria, Fondazione IRCCS Ospedale Maggiore e Università di Milano).

Clincal data monitoring and revision: Valentina Spirito, Damia Noce, Jacopo Bonazzi, Rossana Lombardo, Luigi De Vittorio (Istituto di Ricerche Farmacologiche “Mario Negri”, Milano).

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Nobili, A., Licata, G., Salerno, F. et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol 67, 507–519 (2011). https://doi.org/10.1007/s00228-010-0977-0

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  • DOI: https://doi.org/10.1007/s00228-010-0977-0

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