Citation

Lunardi N, Mehta A, Ezzeddine H, Varma S, Winfield RD, Kent A, Canner JK, Nathens AB, Joseph BA, Efron DT, Sakran JV. J. Trauma Acute Care Surg. 2019; 87(1): 188-194.

Affiliation

Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002339

PMID

31045723

Abstract

INTRODUCTION: Long-term outcomes after trauma admissions remains understudied. We analyzed the characteristics of inpatient readmissions within six-months of an index hospitalization for traumatic injury.

METHODS: Using the 2010-2015 Nationwide Readmissions Database, which captures data from up to 27 U.S. States, we identified patients at least 15-years-old admitted to a hospital through an emergency department for blunt trauma, penetrating trauma, or burns. Exclusion criteria included hospital transfers, patients who died during their index hospitalizations, and hospitals with fewer than 100 trauma patients annually. After calculating the incidences of all-cause, unplanned inpatient readmissions within one-, three-, and six-months, we used multivariable logistic regression models to identify predictors of readmissions. Analyses adjusted for patient, clinical, and hospital factors.

RESULTS: Among 2,763,890 trauma patients, the majority had blunt injuries (92.5%), followed by penetrating injuries (6.2%) and burns (1.5%). Overall, rates of inpatient readmissions were 11.1% within one-month, 21.6% within six-months, and 29.8% within six-months, with limited variability by year. After adjustment, the following were associated with all-cause six-months inpatient readmissions: male sex (adjusted odds ratio [aOR] 1.10 [95%-CI: 1.09-1.10]), comorbidities (aOR 1.21 [1.21-1.22]), low (first and second) income quartiles (aOR 1.08 [1.07-1.10] and aOR 1.04 [1.03-1.06] respectively), Medicare (aOR 1.65 [1.62-1.69]), Medicaid (aOR 1.51 [1.48-1.53]), being treated at private, investor owned hospitals (aOR 1.15 [1.12-1.18]), longer hospital length of stay (aOR 1.01 [1.01-1.01]) and patient disposition to short-term hospital (aOR 1.55 [1.49-1.62]), skilled nursing facility (aOR 1.43 [1.42-1.45]), home health care (aOR 1.27 [1.25-1.28]), or leaving against medical advice (aOR 1.85 [1.78-1.92]).

CONCLUSION: Unplanned readmission after trauma is high and remains this way six months after discharge. Understanding the factors that increase the odds of readmissions within one-, three-, and six-months offer a focus for quality improvement and have important implications for hospital benchmarking. LEVEL OF EVIDENCE: Level 3, Epidemiological.

Language: en