Readmission and its Causes and Costs in Inpatients of a General University Hospital in East of Iran



Background: Readmission is a hospital quality and outcome measure. The aim of this study was to investigate
the rate of readmission and its causes and costs in inpatient wards of a university hospital in Iran.
Methods: One-year data from a 320-bed training center were extracted to determine readmission, admission,
final diagnosis, and costs. According to a specialized study, readmission cases were classified into one of 20
groups, and one of the 10 causes of the disease. Data analysis was performed using chi-square and logistic
regression tests via SPSS software.
Findings: Out of a total of 17,542 hospitalizations, 1214 (6.92%) were readmitted, accounting for 8.27% of the total
hospitalization costs. Among the classes of causes of readmission, unrelated complications of disease and recurrence
of the disease were the most common causes of readmission, respectively. Among the inpatient wards, the highest
percentage of readmission was related to the gynecology ward. The results of multiple logistic regression showed that
the chances of readmission in the age groups between 15 to 65 years and under 15 years, was respectively 32.3%
[confidence interval (CI): 0.78-0.58; odds ratio (OR) = 0.67] and 58.1% (CI: 0.51-0.32; OR = 0.41) lower than the age
group over 65 years (P < 0.050). The chance of readmission in patients covered by social security, accidental, health
and miscellaneous insurance was respectively 35.0% (CI: 0.50-0.84; OR = 0.65), 37.8% (CI: 0.43-0.89; OR = 0.62),
23.1% (CI: 0.98-0.59; OR = 0.76) and 68.9% (CI: 0.89-0.11; OR = 0.32) lower than patients with armed insurance
coverage (P < 0.050).
Conclusion: The results of the study indicate the importance of monitoring the rate, process, and costs of
readmission as one of the key indicators of hospital performance quality.


Hasan M. Readmission of patients to hospital: Still ill defined and poorly understood. Int J Qual Health Care 2001; 13(3): 177-9.
Ministry of Health and Medical Education. Comprehensive guide to national accreditation standards of Iran's hospitals. 4th ed. Tehran, Iran: Ministry of Health and Medical Education; 2020. [In Persian].
Beagley J, Hlavac J, Zucchi E. Patient length of stay, patient readmission rates and the provision of professional interpreting services in healthcare in Australia. Health Soc Care Community 2020; 28(5): 1643-50.
Banerjee S, Paasche-Orlow MK, McCormick D, Lin MY, Hanchate AD. Association between Medicare’s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share. BMC Health Serv Res 2021; 21(1): 248.
Sajadi S, Hosseini SM, Alimohammadzadeh K. Assessment of prevalence of readmission in admitted ward of Tehran Oil Company’s Hospital in 2016. Nurs Midwifery J 2018; 16(1): 1-11. [In Persian].
Regenstein M, Andres E. Reducing hospital readmissions among medicaid patients: a review of the literature. Qual Manag Health Care 2014; 23(1): 20-42.
Ashktorab T, Bathaei SA, Zohari Anbuhi S, Alavi Majd H, Ezati J. Factors contributing to readmission of congestive heart failure patients admitted in internal ward of hospitals of Shahid Beheshti University of Medical Sciences in Tehran. Advances in Nursing and Midwifery 2011; 21(72): 19-24. [In Persian].
Hekmatpou D, Mohammadi E, Ahmadi F, Arefi SH. Barriers of readmission control among patients with congestive heart failure: A qualitative study. J Arak Uni Med Sci 2008; 11(4): 49-58. [In Persian].
Elliott M. Readmission to intensive care: A review of the literature. Aust Crit Care 2006; 19(3): 96-4.
Arab M, Eskandari Z, Rahimi A, Pourreza A, Dargahi H. Reasons for patients' readmission in Tehran University of Medical Sciences hospitals. Hospital 2010; 9(1): 43-56. [In Persian].
Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: Current strategies and future directions. Annu Rev Med 2014; 65: 471-85.
Kariman H, Shahrami A, S Nikanjam. Causes of readmission to emergency department; a cross-sectional study. Iran J Emerg Med 2020; 7(1): 5. [In Persian].
Strobe [Online]. [cited 2021]; Available from: URL:
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360(14): 1418-28.
Shahbandari M, Parsamatin SK. The causes of readmission in patients with lower limb amputation due to ischemia. J Isfahan Med Sch 2019; 37(513): 16-22. [In Persian].
Haghighi H. A survey on the frequency of reasons and expenses of readmission of patients with kidney transplantation in Montaserie Organ Transplantation Hospital 2011-2014. Mashhad, Iran: Mashhad University of Medical Sciences; 2014. [In Persian].
Nemati E, Saadat AR, Hashemi M, Khoddami-Vishteh HR, Moghani-Lankarani M. Causes of rehospitalization after renal transplantation; does age of recipient matter? Transplant Proc 2007; 39(4): 970-3.
Lak M, Jalali AR, Badrkhahan SF, Hashemi M, Azizabadi FM, Kardavani B, et al. Additional burden of intensive care to rehospitalizations following kidney transplantation: a study of rate, causes, and risk factors. Iran J Kidney Dis 2008; 2(4): 212-7.
Wanklyn P, Hosker H, Pearson S, Belfield P. Slowing the rate of acute medical admissions. J R Coll Physicians Lond 1997; 31(2): 173-6.
Singh G, McCormack D, Roberts DR. Readmission and overstay after day case nasal surgery. BMC Ear Nose Throat Disord 2004; 4(1): 2.