TY  - JOUR
PY  - 2019//
TI  - Unplanned readmission after traumatic injury: a long-term nationwide analysis
JO  - Journal of trauma and acute care surgery
A1  - Lunardi, Nicole
A1  - Mehta, Ambar
A1  - Ezzeddine, Hiba
A1  - Varma, Sanskriti
A1  - Winfield, Robert D.
A1  - Kent, Alistair
A1  - Canner, Joseph K.
A1  - Nathens, Avery B.
A1  - Joseph, Bellal A.
A1  - Efron, David T.
A1  - Sakran, Joseph V.
SP  - 188
EP  - 194
VL  - 87
IS  - 1
N2  - 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. <br><br>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. <br><br>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]). <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000002339
ID  - ref1
ER  -