David Metcalfe1, Olubode A Olufajo2, Cheryl K Zogg2, Arturo Rios-Diaz2, Mitchel Harris3, Michael J Weaver3, Adil H Haider2, Ali Salim2. 1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK; Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA. Electronic address: david.metcalfe@ndorms.ox.ac.uk. 2. Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA. 3. Department of Orthopedic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Abstract
INTRODUCTION: 30-day readmission is increasingly used as a hospital quality metric. The objective of this study was to describe the patient factors associated with unplanned 30-day hospital readmission of orthopaedic trauma patients. METHODS: A statewide observational study was undertaken using data from all acute hospitals in California. All hospital inpatients with a primary diagnosis of fracture or dislocation (ICD-9-CM codes 800-829) were included, except for those with isolated injuries to the skull, face, or ribs. The primary outcome measure was unplanned 30-day readmission to any hospital in California. RESULTS: 416,568 trauma admissions were available for analysis. The overall readmission rate was 6.5%, and 27.3% of readmitted patients presented to a different hospital. Factors significantly associated with readmission were male sex (OR 1.23, 95% CI 1.19-1.27), age 46-65 (2.61 [2.27-2.99]), black race (1.19 [1.11-1.27]), entitlement to publicly funded healthcare (1.38 [1.25-1.52]), Charlson Comorbidity Index ≥2 (1.84 [1.79-1.90]), discharge against medical advice (3.13 [2.67-3.68]), and spinal fracture (1.42 [1.34-1.49]). Major reasons for readmission included: cardiopulmonary disease (25.6%), infections (20.1%), musculoskeletal problems (18.1%), and procedural complications (12.0%). CONCLUSIONS: Many orthopaedic trauma readmissions are potentially unrelated to the initial hospitalization. Penalties for unplanned readmissions risk penalizing hospitals that serve disadvantaged communities and treat a high proportion of trauma patients.
INTRODUCTION: 30-day readmission is increasingly used as a hospital quality metric. The objective of this study was to describe the patient factors associated with unplanned 30-day hospital readmission of orthopaedic traumapatients. METHODS: A statewide observational study was undertaken using data from all acute hospitals in California. All hospital inpatients with a primary diagnosis of fracture or dislocation (ICD-9-CM codes 800-829) were included, except for those with isolated injuries to the skull, face, or ribs. The primary outcome measure was unplanned 30-day readmission to any hospital in California. RESULTS: 416,568 trauma admissions were available for analysis. The overall readmission rate was 6.5%, and 27.3% of readmitted patients presented to a different hospital. Factors significantly associated with readmission were male sex (OR 1.23, 95% CI 1.19-1.27), age 46-65 (2.61 [2.27-2.99]), black race (1.19 [1.11-1.27]), entitlement to publicly funded healthcare (1.38 [1.25-1.52]), Charlson Comorbidity Index ≥2 (1.84 [1.79-1.90]), discharge against medical advice (3.13 [2.67-3.68]), and spinal fracture (1.42 [1.34-1.49]). Major reasons for readmission included: cardiopulmonary disease (25.6%), infections (20.1%), musculoskeletal problems (18.1%), and procedural complications (12.0%). CONCLUSIONS: Many orthopaedic trauma readmissions are potentially unrelated to the initial hospitalization. Penalties for unplanned readmissions risk penalizing hospitals that serve disadvantaged communities and treat a high proportion of traumapatients.
Authors: Daniel R Evans; Alexander L Lazarides; Mark M Cullen; Julia D Visgauss; Jason A Somarelli; Dan G Blazer; Brian E Brigman; William C Eward Journal: Ann Surg Oncol Date: 2021-05-20 Impact factor: 5.344
Authors: Daniel R Evans; Alexander L Lazarides; Mark M Cullen; Jason A Somarelli; Dan G Blazer; Julia D Visguass; Brian E Brigman; William C Eward Journal: Ann Surg Oncol Date: 2021-09-27 Impact factor: 5.344
Authors: Elizabeth Y Killien; Roel L N Huijsmans; Monica S Vavilala; Anneliese M Schleyer; Ellen F Robinson; Rebecca G Maine; Frederick P Rivara Journal: J Surg Res Date: 2021-04-10 Impact factor: 2.417
Authors: Raj M Amin; Alexander E Loeb; Erik A Hasenboehler; Adam S Levin; Greg M Osgood; Robert S Sterling; Philip F Stahel; Babar Shafiq Journal: Patient Saf Surg Date: 2019-06-14
Authors: Brian D Batko; Jeremy Hreha; James S Potter; Luis Guinand; Mark C Reilly; Michael S Sirkin; Michael M Vosbikian; Mark R Adams Journal: J Clin Orthop Trauma Date: 2021-05-02