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Hospital Readmission After Traumatic Brain Injury Hospitalization in Community-Dwelling Older Adults
Rachel Thomas1, Connor A Law1, Joan A Casey2,3
1Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Objective:
To examine the risk of hospital readmission after an index hospitalization for TBI in older adults.
Methods:
Using data from the Atherosclerosis Risk in Communities (ARIC) study, we used propensity score matching of individuals with an index TBI-related hospitalization to individuals with (1) non-TBI hospitalizations (primary analysis) and (2) orthopedic injury hospitalizations (secondary analysis). The rate of all-cause hospital readmission was estimated using adjusted Fine-Gray proportional hazards regression models within strata defined by time since hospitalization. Follow-up extended from the date of index hospitalization after study enrollment (1987-1989) through December 31, 2019.
Results:
Six hundred sixty-seven participants with an index TBI-related hospitalization were matched using propensity scores with replacement with a ratio of 1:4-2668 participants with non-TBI-related hospitalizations and 1:3 with 2001 participants with orthopedic injury-related hospitalizations. Median age was 68 years (IQR = 46-95) at index hospitalization. Compared to participants with an index non-TBI-related hospitalization, readmission rates were lower among participants with an index TBI-related hospitalization (HR = 0.80, 95% CI = 0.74, 0.87) over a median follow-up of 2.7 years, although similar readmission rates were observed within the first year of follow-up (HR = 1.03, 95% CI = 0.88, 1.21). Rates of hospital readmission among persons with an index TBI-related hospitalization were similarly decreased compared with persons with an orthopedic injury-related hospitalization (HR = 0.78, 95% CI = 0.72, 0.85) over a median follow-up of 3.1 years.
Interpretation:
Among community-dwelling older adults with a TBI-related hospitalization, rates of hospital readmission were similar to individuals hospitalized for a non-TBI cause in the first year, but lower subsequently. Targeted interventions in the first year post-hospitalization may be most beneficial for reducing readmissions among individuals with TBI.
