Association of unhealthy alcohol use reported in routine outpatient screening with 30-day hospital readmission risk

Unplanned hospital readmissions within 30 days of hospital discharge are an important quality metric for hospital care. Characterizing the associations of alcohol use screening scores completed in outpatient care and risk of hospital readmissions may guide healthcare systems as they work to reduce unplanned readmissions. This retrospective cohort study examines the association between severity of alcohol use reported in outpatient settings and 30-day risk for unplanned hospital readmissions for patients in a large integrated health system.

Using claims records, we identified "index hospitalizations" and unplanned readmissions within 30 days of discharge. We measured unhealthy alcohol use using AUDIT-C scores documented in medical records in routine outpatient care up to one year before index hospitalizations. We calculated risk estimates using generalized estimating equations with adjustment for age, sex, race, ethnicity, and neighborhood deprivation.

57,421 index hospitalizations met inclusion criteria and 11.5% had an unplanned readmission within 30 days. Compared to those with AUDIT-C scores of 1-2(female)/1-3(male) (reflecting lower-risk drinking), AUDIT-C scores of 0 (non-drinking) were associated with a higher risk of readmission (relative risk [RR] = 1.22, 95% CI: 1.15-1.30), while AUDIT-C scores 3-6(female)/4-6(male) (reflecting moderate-risk drinking) were associated with a lower risk of readmission (RR = 0.89, 95% CI: 0.81-0.96). Associations were no longer significant after secondary adjustment for tobacco use, body mass index, and medical comorbidities.

Contrary to hypotheses, higher AUDIT-C scores were not significantly associated with elevated risk of readmissions. Factors other than unhealthy alcohol use may explain variation in readmission risk.