Early hospital readmission in the trauma population: Are the risk factors different?

Abstract

Introduction Hospital readmission rates will soon impact Medicare reimbursements. While risk factors for readmission have been described for medical and elective surgical patients, little is known about their predictive value specifically in trauma patients. Patients and methods We retrospectively identified all admissions after trauma resuscitation to our urban level 1 trauma centre from 1/1/2004 to 8/31/2010. All patients discharged alive were included. Data collected included demographics, Injury Severity Score (ISS), and length of stay (LOS). We analyzed these index admissions for the development of complications that have previously been shown to be associated with readmission. Readmissions that occurred within 30 days of index admission were identified. Univariable and multivariable analyses were performed. p < 0.05 was considered significant. Results We identified 10,306 index admissions, with 447 (4.3%) early (within 30 days) readmissions. Mean ISS was 11.1 (SD 10.4). On multivariable analysis, African-American race (OR 1.3, p = 0.009), preexisting chronic obstructive pulmonary disease (COPD) (OR 1.5, p = 0.02), and diabetes mellitus (OR 1.8, p < 0.001) were associated with readmission, along with higher ISS (OR 1.01, p < 0.001), ICU admission (OR 2.1, p < 0.001), and increased LOS (OR 1.01, p < 0.001). Among many in-hospital complications examined, only the development of surgical site infection (SSI) (OR 1.9, p = 0.02) was associated with increased risk of readmission. Conclusions Trauma patients have a low risk of readmission. In contrast to elective surgical patients, the only modifiable risk factor for readmission in our trauma population was SSI. Other risk factors may present clinicians with opportunities for targeted interventions, such as proactive follow up or early phone contact. With future changes to health care policy, clinicians may have even greater motivation to prevent readmission.

Early unplanned hospital readmission after acute traumatic injury: the experience at a state-designated level-I trauma center

“…This is consistent with the lower trauma readmission rate reported by others; it is lower than readmission rates reported for common medical or surgical diagnoses. 1,5,[7][8][9] Readmissions were resource intensive, as 15.9% required surgery during readmission. This need for surgical intervention is consistent with that reported by others.…”

“…These studies have found that trauma patients have lower readmission rates as compared with other patient populations. [5][6][7][8][9] Interestingly, commonly perceived risk factors such as hospital length of stay (LOS) and injury severity score (ISS) were not necessarily associated with clinically meaningful data. For example, in a multivariate analysis of trauma readmissions at a large urban academic trauma center, ISS and LOS were associated with an odds ratio (OR) of 1.01 for readmission; albeit statistically significant, the clinical relevance is minimal.…”

“…For example, in a multivariate analysis of trauma readmissions at a large urban academic trauma center, ISS and LOS were associated with an odds ratio (OR) of 1.01 for readmission; albeit statistically significant, the clinical relevance is minimal. 9 There is further paucity of data for suburban trauma centers. We evaluated trauma readmissions at a suburban, state-designated level-I academic trauma center to determine their incidence, risk factors, and implications thereof.…”

Risk Factors For Unplanned Readmission In Older Adult Trauma Patients In Our Institute

“…This study used competing risk regression and shows that patients with the high risk of readmission in year after injury were those who had falls/severe head injury/ index ICU admission. Previous studies shown that 30-day readmission rates after trauma range from 4.2% to 13.3% 17,18,26 . Spector and colleagues 17 focused on older adults, finding a 30-day readmission rate which was higher than current study (13.3% vs 7.9%) 17 .…”

“…However surgical patients (including trauma patients) have not received the same level of attention 16,17,18 . We undertook this study with aims to determine the unplanned admissions after hospitalisations for trauma and 21 .…”