B. C. Housley1, N. J. Kelly1, F. J. Baky1, S. P. Stawicki2, D. C. Evans1, C. Jones1 1The Ohio State University,College Of Medicine,Columbus, OH, USA 2St. Luke’s University Health Network,Department Of Research & Innovation,Bethlehem, PA, USA
Introduction: Hospital readmissions correlate with worse outcomes and may soon lead to decreased reimbursement. The comorbidity-polypharmacy score (CPS) is the sum of the number of pre-injury medications and the number of comorbidities, and may estimate patient frailty more effectively than patient age does. Though CPS has previously been correlated with patient discharge destination and clinical outcomes, no information is currently available regarding the association between CPS and hospital readmission. This study evaluates that association, and compares it to age and injury severity as predictors for readmission.
Methods: We retrospectively evaluated all injured patients 45 years or older seen at our American College of Surgeons-verified Level 1 trauma center over a one-year period. Inmates, patients who died prior to discharge, and patients who were discharged to hospice care were excluded. Institutional trauma registry data and electronic medical records were reviewed to obtain information on demographics, injuries, pre-injury comorbidities and medications, ICU and hospital lengths of stay, and occurrences of readmission to our facility within 30 days of discharge. Kruskal-Wallis testing was used to evaluate differences between readmitted patients and those who were not, with logistic regression used to evaluate the contribution of individual risk factors for readmission.
Results: 960 patients were identified; 79 patients were excluded per above criteria, and 2 further were excluded due to unobtainable medical records. 879 patients were included in final analysis; their ages ranged from 45-103 (median 58) years, injury severity scores (ISS) from 0-50 (median 5), and CPS from 0-39 (median 7). 76 patients (8.6%) were readmitted to our facility within 30 days of discharge. The readmitted cohort had higher CPS (median 9.5, p=0.031) and ISS (median 9, p=0.045), but no difference in age (median 59.5, p=0.646). Logistic regression demonstrated independent association of higher CPS with increased risk of readmission, with each CPS point increasing the odds of readmission by 3.9% (p=0.01).
Conclusion: CPS is simple to calculate and, despite assumed limited accuracy of this information early in a trauma patient’s hospitalization, appears to correlate well with readmissions within 30 days. Indeed, frailty defined by CPS was a significantly stronger predictor of readmission than patient age was. Early recognition of elevated CPS may help optimize discharge planning and potentially decrease readmission rates in older trauma patients; larger multicenter evaluations of CPS as a readily available indicator for the frailty of older patients are warranted.