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Predictors of readmission in orthopaedic trauma surgery
Michiel G J S Hageman1, Jeroen K J Bossen, R Malcolm Smith
1Orthopaedic Department, Massachusetts General Hospital, Boston, MA.
Objectives:
This study of patients who had operative treatment of skeletal trauma addresses (1) the association between readmission within 30 days of discharge and comorbidities and (2) differences in factors associated with all-cause readmissions and those because of a surgical adverse event.
Design:
Retrospective study.
Setting:
Tertiary care referral center.
Patients:
Three thousand four hundred fifty-two operations for skeletal trauma between 2008 and 2012 with comorbidities quantified using the updated Charlson comorbidity index (CCI).
Outcome Measurement:
Readmission to the hospital within 30 days of surgery and the subset of readmissions because of adverse events related directly to surgery.
Results:
There was a significant association between readmission within 30 days of surgery and higher CCI (P < 0.001), older age (P < 0.001), and marital status (widowed) (P < 0.001). The factors associated with readmission related to an adverse event were identical. The best multivariable logistic regression models for all-cause 30-day readmission and 30-day readmission related to a surgical adverse event included CCI and older age in both models (odds ratio 1.1, P < 0.01, pseudo R = 0.03).
Conclusions:
Older patients and patients with greater comorbidity are more likely to be readmitted within 30 days of surgery for musculoskeletal trauma, whether for a surgical adverse event or another reason. The best multivariable models predicted very little of the variability in readmission, which reflects the complexity of readmission and the difficulty reducing the risk to a few specific factors.
Level Of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
