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Unplanned readmission after traumatic injury: A long-term nationwide analysis
Nicole Lunardi1, Ambar Mehta, Hiba Ezzeddine
1From the School of Medicine, Johns Hopkins University (N.L., S.V.), Baltimore, Maryland; Department of Surgery (A.M.), New York-Presbyterian Columbia University Medical Center, New York, New York; Department of Surgery (H.E., A.K., J.K.C., D.T.E., J.V.S.), Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery (R.D.W.), Kentucky University Medical Center, Lexington, Kentucky; Department of Surgery (A.B.N.), University of Toronto, Toronto, ON, Canada; and Department of Surgery, University of Arizona College of Medicine (B.A.J.), Tucson, Arizona.
Insights
High rates of unplanned inpatient readmissions after trauma persist within six months. Key predictors include male sex, comorbidities, lower income, and specific insurance types, informing quality improvement efforts.
Area of Science:
- Trauma surgery
- Health services research
- Epidemiology
Background:
- Long-term outcomes following trauma admissions are understudied.
- This study analyzes characteristics of inpatient readmissions within six months of initial trauma hospitalization.
Purpose of the Study:
- To analyze the characteristics of inpatient readmissions within 6 months of index trauma hospitalization.
- To identify predictors of all-cause, unplanned inpatient readmissions within 1, 3, and 6 months post-discharge.
Main Methods:
- Utilized the 2010-2015 Nationwide Readmissions Database for patients aged 15+ admitted via emergency department for blunt trauma, penetrating trauma, or burns.
- Excluded hospital transfers, patients deceased during index hospitalization, and hospitals with <100 annual trauma patients.
- Employed multivariable logistic regression, adjusting for patient, clinical, and hospital factors, to identify readmission predictors.
Main Results:
- Analyzed 2,763,890 trauma patients; blunt injuries were most common (92.5%).
- Overall inpatient readmission rates were 11.1% (1 month), 21.6% (3 months), and 29.8% (6 months).
- Predictors of 6-month readmission included male sex, comorbidities, low income, Medicare/Medicaid insurance, private hospital care, longer stays, and disposition to non-home settings.
Conclusions:
- Unplanned readmission rates after trauma are high and remain consistent up to six months post-discharge.
- Identifying factors associated with readmissions provides a focus for quality improvement initiatives.
- Findings have significant implications for hospital performance benchmarking and patient outcome monitoring.
Background:
Long-term outcomes after trauma admissions remain understudied. We analyzed the characteristics of inpatient readmissions within 6 months of an index hospitalization for traumatic injury.
Methods:
Using the 2010 to 2015 Nationwide Readmissions Database, which captures data from up to 27 US 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 1 month, 3 months, and 6 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 1 month, 21.6% within 6 months, and 29.8% within 6 months, with limited variability by year. After adjustment, the following were associated with all-cause 6 months inpatient readmissions: male sex (adjusted odds ratio [aOR], 1.10; 95% confidence interval [95% CI], 1.09-1.10), comorbidities (aOR, 1.21; 95% CI, 1.21-1.22), low-income quartiles (first and second) (aOR, 1.08; 95% CI, 1.07-1.10 and aOR, 1.04; 95% CI, 1.03-1.06, respectively), Medicare (aOR, 1.65; 95% CI, 1.62-1.69), Medicaid (aOR, 1.51; 95% CI, 1.48-1.53), being treated at private, investor-owned hospitals (aOR, 1.15; 95% CI, 1.12-1.18), longer hospital length of stay (aOR, 1.01; 95% CI, 1.01-1.01) and patient disposition to short-term hospital (aOR, 1.55; 95% CI, 1.49-1.62), skilled nursing facility (aOR, 1.43; 95% CI, 1.42-1.45), home health care (aOR, 1.27; 95% CI, 1.25-1.28), or leaving against medical advice (aOR, 1.85; 95% CI, 1.78-1.92).
Conclusion:
Unplanned readmission after trauma is high and remains this way 6 months after discharge. Understanding the factors that increase the odds of readmissions within 1 month, 3 months, and 6 months offer a focus for quality improvement and have important implications for hospital benchmarking.
Level Of Evidence:
Epidemiological study, level III.
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