Unplanned readmission after traumatic injury: A long-term nationwide analysis

Nicole Lunardi, Ambar Mehta, Hiba Ezzeddine, Sanskriti Varma, Robert D. Winfield, Alistair Kent, Joseph K. Canner, Avery B. Nathens, Bellal A. Joseph, David T. Efron, Joseph V. Sakran

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)188-194
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume87
Issue number1
DOIs
StatePublished - Jul 1 2019

Keywords

  • nationwide
  • readmissions
  • Trauma
  • unplanned

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Lunardi, N., Mehta, A., Ezzeddine, H., Varma, S., Winfield, R. D., Kent, A., Canner, J. K., Nathens, A. B., Joseph, B. A., Efron, D. T., & Sakran, J. V. (2019). Unplanned readmission after traumatic injury: A long-term nationwide analysis. Journal of Trauma and Acute Care Surgery, 87(1), 188-194. https://doi.org/10.1097/TA.0000000000002339