NEJM Perspective: Post-Hospital Syndrome — An Acquired, Transient Condition of Generalized Risk

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Is there really a post hospital discharge syndrome? A generalized and transitory risk condition that favors the onset of pathologies after hospital discharge, when the acute condition for which the patient had arrived in hospital has clinically resolved.
In the USA, almost a fifth of patients, mostly elderly, after a first hospitalization undergo a second hospitalization in the following month, also for reasons other than the previous one. This is the time window in which the “post-hospital syndrome” manifests itself, that is a transitory period of vulnerability acquired after discharge. How can this be remedied?

In an interesting interview, conducted by the New England Journal of Medicine in early 2013, Dr Harlam Krumholz, of Yale University School of Medicine, identifies the need to intervene in the organization of the management of surgical patients hospitalized for acute events: according to the ‘The interviewee on the one hand requires greater attention to the patient’s primary needs during hospitalization (the problem of nosocomial infections should not be underestimated), on the other hand accompanying him in the post-discharge phase to facilitate recovery.

During hospitalization, patients experience a state of generalized stress due to multiple factors that can negatively influence the recovery phase. There are many patients with circadian cycle alterations and sleep disturbances, debilitating both from a physical point of view and from a physiological point of view, as they compromise the functionality of the immune system and interfere with the coagulation cascade, favoring the onset of problems. cardiovascular. The hospital diet is also a negative factor: it can be deficient; the delay and cancellation of the execution of diagnostic tests to be carried out on an empty stomach or the failure to supply bags for parenteral nutrition are among the most common sources of stress.

There are several factors identified that unite patients suffering from the post-discharge syndrome: pain, discomfort felt during hospitalization, often unpredictable schedules, mood disorders, the administration of benzodiazepines in symptomatic therapy, all elements that contribute to predisposing the patient to secondary problems and which negatively influence the patient’s adherence to the therapy prescribed for the post-discharge period.
To remedy the eventuality of a second hospitalization with a different diagnosis, an in-depth study of patients hospitalized for a second time for reasons other than the first hospitalization is necessary. The study must investigate the contributing factors of the second hospitalization to allow intervention on the hospital organization to avoid secondary damage in the future to hospital attempts to resolve the acute pathology that brought the patient to hospital.