D. S. Strosberg2, B. C. Housley3, D. Vazquez1, A. Rushing1, C. Jones1 1Ohio State University,Department Of Surgery, Division Of Trauma, Critical Care, And Burn,Columbus, OH, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA 3Ohio State University,College Of Medicine,Columbus, OH, USA
Introduction: Unplanned readmissions are a major quality measure used to evaluate hospital care. Readmissions after traumatic injury are frequent, and older trauma patients are at increased risk for poor outcomes in both morbidity and mortality. Determining an appropriate destination after discharge in this population is difficult, and may impact readmission rates. Prior literature evaluating discharge destination’s impact on patient outcome is limited and conflicting; no prior study has evaluated this relationship in older trauma patients. The objective of this study was to explore the association between the discharge destination and rate of 30-day readmission in older trauma patients.
Methods: A database of all patients age 45 years or older undergoing trauma evaluation at our American College of Surgeons verified level 1 trauma center over a 1-year period was used to retrospectively compare frequency of 30-day readmission to the center between patients discharged to home, to inpatient rehabilitation facilities, and to other extended care facilities (ECFs, including long term acute care hospitals, skilled nursing facilities, and nursing homes). Further abstracted potentially confounding factors were trauma activation level, injury severity score, comorbidity-polypharmacy score, age, hospital length of stay (LOS), ICU LOS, Glasgow coma score, gender, pre-trauma functional status (independent, partially dependent, or dependent), and pre-trauma residence (home, rehab, or ECF). Inmates, patients who died during their hospitalizations, and patients who were discharged to hospice were excluded from analysis. Univariate analysis was undertaken using chi-square testing. Multiple logistic regression was performed with all the above variables to evaluate for independent contribution to readmission risk.
Results: 960 patients age 45 and older were evaluated over the study period; 81 (8.4%) were excluded and 879 patients age 45-103 were included in the analysis. Seventy-six patients (8.6%) were readmitted within 30 days of discharge, including 6% of patients discharged to home, 14% discharged to ECF, and 19% discharged to rehab (p=0.00009 on univariate analysis). 557 (63%) patients had data recorded for all variables analyzed using multiple logistic regression; among these, only discharge destination was independently associated with the rate of readmission (p=0.019).
Conclusion: Unplanned hospital readmission following traumatic injury is common in older patients and is used as a marker of hospital quality. In this first study of outcomes based on discharge destination of older trauma patients, discharge to inpatient rehabilitation or other extended care facilities was a strong independent risk factor for hospital readmissions. Though causes of this association are likely multifactorial, recognition of this risk factor may aid in the disposition planning of these patients and suggests the need for further evaluation of this correlation at other centers.