Z. G. Hashmi1,2, C. K. Zogg3, M. P. Jarman1, A. Salim1, A. H. Haider1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Sinai Hospital Of Baltimore,Surgery,Baltimore, MD, USA 3Yale University School Of Medicine,New Haven, CT, USA
Introduction: Up to 10% of trauma patients are readmitted after their index hospitalization leading to worse outcomes and increased costs. Understanding patient factors that increase the risk of unplanned readmissions will enable us to develop interventions to mitigate this problem of “bounce-backs”. The objective of this study is to determine if unplanned hospital admissions in the 90-days before the index trauma are associated with increased risk of 30-day unplanned readmissions after trauma.
Methods: Adult patients (age ≥16y) with blunt/penetrating injuries included in the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) 2014 were analyzed. All unplanned admissions in the 90-days before a trauma admission (pre-trauma admissions, PTAs) and within 30-day after a trauma discharge (trauma readmissions, TRs) were noted. Weighted multivariable logistic regression, with TR as the primary outcome, was performed, adjusting for age, sex, insurance status, injury mechanism, Injury Severity Score, head Abbreviated Injury Scale and All Patient Refined-Diagnosis Related Group severity, to ascertain the association of PTAs with TRs. We also matched patients with and without PTAs using Coarsened Exact Matching for sensitivity analyses.
Results: A total of 235,978 patients were analyzed. The overall PTA rate was 3.2%(7,646/235,978) and the TR rate was 4.6%(10,924/235,978). Among those readmitted, 10.5%(1,145/10,924) had ≥1 PTA. These patients were older(≥65y: 71.8% vs 68.2%) and sustained more falls(89.1% vs 76.5%) compared to readmitted patients without PTAs(p<0.01 for both). Most PTA patients(81.6%) had a medical hospitalization and were subsequently discharged to a skilled nursing facility(62%) before their trauma visit. Unadjusted TR rate was higher for patients who had a PTA versus those who did not(15% versus 4.3%, p<0.001). Even after adjusting for multiple patient factors, both the presence of a PTA [2.9 (2.7-3.2); OR (95% CI)] and the number of PTAs(Fig1) significantly increased the risk of TR. Sensitivity analyses demonstrated similar findings.
Conclusion: The number of unplanned hospital admissions 90-days prior to a trauma admission is highly associated with 30-day unplanned readmission after trauma. Asking patients/caregivers regarding admissions in the last 90 days can provide a simple way to identify patients who may benefit from interventions to reduce the risk for readmission. These may include ensuring pre-discharge medical optimization, appropriate post-discharge care coordination and fall prevention. This study highlights a target population for interventions to break the self-perpetuating “bounce-back” cycle among frequently admitted trauma patients.
