Citation

Passman J, Xiong R, Hatchimonji J, Kaufman E, Sharoky C, Yang W, Smith BP, Holena D. J. Surg. Res. 2020; 250: 209-215.

Affiliation

Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.jss.2019.12.027

PMID

32092598

Abstract

BACKGROUND: Unplanned readmissions of surgical patients are associated with increased morbidity and mortality. "Fragmentation of care" (FOC) occurs when patients are readmitted to a different hospital than where they initially received care. FOC complicates accurate quantification of hospital readmission rates and is associated with worse outcomes in many surgical patient populations. However, few studies have evaluated the impact of FOC specifically on patients with traumatic injury.

MATERIALS AND METHODS: We performed a retrospective cohort study using the 2013 National Readmissions Database. Data on demographics, diagnosis, injury severity, readmissions, complications, and outcomes were collected. Patients readmitted to hospitals within 30 d after index admission were identified, and risk factors for readmission were discerned. Patients were stratified into groups readmitted to index versus nonindex hospital. Outcomes were compared between these groups.

RESULTS: A total of 333,188 patients with index admission for injury were identified; 34,197 (10.3%) were readmitted within 30 d of discharge. Of these, only 24,747 (72.4%) were readmitted to their index hospital for an FOC rate of 27.6%. There was no significant difference in outcomes between patients readmitted to index versus nonindex hospitals. Among all readmitted patients, 30-d mortality was associated only with burden of medical comorbidities and age.

CONCLUSIONS: Single-institution readmission rates are not reflective of true readmission rates for trauma patients. FOC does not impact outcomes in trauma patients who are readmitted; however, age and number of comorbidities are associated with higher mortality in these patients. FOC rates are high in trauma patient populations and merit further investigation to determine potential etiologies and consequences.

Copyright © 2020 Elsevier Inc. All rights reserved.

Language: en

Keywords

Fragmentation of care; Injury; Outcomes; Readmission; Trauma