Risk factors for 30-day hospital readmission after Hospital-at-Home treatment of acute pyelonephritis

Hospital-at-Home programs deliver acute inpatient-level care in patients' homes and have demonstrated favorable outcomes compared with traditional, brick and mortar hospital hospitalization. Pyelonephritis is a common inpatient condition; however, 30-day hospital readmission rates in Hospital-at-Home populations are unknown.

We performed a retrospective cohort study of adults treated for acute pyelonephritis in Mayo Clinic's Hospital at Home program across all three U.S. sites between July 2020 and January 2025. The primary outcome was 30-day all-cause unplanned readmission to a brick-and-mortar hospital or re-enrollment in Hospital-at-Home.

Among 165 patients, 28 (17.0%) experienced a 30-day unplanned readmission. Hospital readmission was not associated with severity of illness, risk of mortality, Charlson Comorbidity Index, sepsis or bacteremia at presentation, Hospital-at-Home admission pathway, or length of stay. In adjusted analyses, the presence of an ileal conduit (P = 0.02) and an indwelling or suprapubic urinary catheter (P = 0.04) were independently associated with higher odds of 30-day hospital readmission.

In this multi-site Hospital-at-Home cohort, 30-day hospital readmission after treatment for acute pyelonephritis was associated with genitourinary complexity rather than illness severity or treatment factors.