Elizabeth Y Killien1, Roel L N Huijsmans2, Monica S Vavilala3, Anneliese M Schleyer4, Ellen F Robinson5, Rebecca G Maine6, Frederick P Rivara7. 1. Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington. Electronic address: elizabeth.killien@seattlechildrens.org. 2. Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; University Medical Center Utrecht, Utrecht, Netherlands. 3. Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington. 4. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington; Hospital Quality and Patient Safety, Harborview Medical Center, Seattle, Washington. 5. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington. 6. Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, , Washington. 7. Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington.
Abstract
BACKGROUND: Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affect risk of readmission after trauma. MATERIALS AND METHODS: We conducted a retrospective cohort study of adult trauma admissions from July 2015 to September 2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-d readmission using multivariable generalized linear Poisson regression models. RESULTS: Of 8916 discharged trauma patients, 330 (3.7%) had an unplanned 30-d readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among postoperative patients included public insurance (adjusted Relative Risk (aRR) 1.34, 95% CI 1.02-1.76), mental illness (aRR 1.39, 1.04-1.85), and chronic renal failure (aRR 2.17, 1.39-3.39); undergoing abdominal, thoracic, or neurosurgical procedures; experiencing an index hospitalization surgical site infection (aRR 4.74, 3.00-7.50), pulmonary embolism (aRR 3.38, 2.04-5.60), or unplanned ICU readmission (aRR 1.74, 1.16-2.62); shorter hospital stay (aRR 0.98/d, 0.97-0.99), and discharge to jail (aRR 4.68, 2.63-8.35) or a shelter (aRR 4.32, 2.58-7.21). Risk factors varied by reason for readmission. Injury severity, trauma mechanism, and body region were not independently associated with readmission risk. CONCLUSIONS: Psychosocial factors and hospital complications were more strongly associated with readmission after trauma than injury characteristics. Improved social support and follow-up after discharge for high-risk patients may facilitate earlier identification of postdischarge complications.
BACKGROUND: Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affect risk of readmission after trauma. MATERIALS AND METHODS: We conducted a retrospective cohort study of adult trauma admissions from July 2015 to September 2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-d readmission using multivariable generalized linear Poisson regression models. RESULTS: Of 8916 discharged trauma patients, 330 (3.7%) had an unplanned 30-d readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among postoperative patients included public insurance (adjusted Relative Risk (aRR) 1.34, 95% CI 1.02-1.76), mental illness (aRR 1.39, 1.04-1.85), and chronic renal failure (aRR 2.17, 1.39-3.39); undergoing abdominal, thoracic, or neurosurgical procedures; experiencing an index hospitalization surgical site infection (aRR 4.74, 3.00-7.50), pulmonary embolism (aRR 3.38, 2.04-5.60), or unplanned ICU readmission (aRR 1.74, 1.16-2.62); shorter hospital stay (aRR 0.98/d, 0.97-0.99), and discharge to jail (aRR 4.68, 2.63-8.35) or a shelter (aRR 4.32, 2.58-7.21). Risk factors varied by reason for readmission. Injury severity, trauma mechanism, and body region were not independently associated with readmission risk. CONCLUSIONS: Psychosocial factors and hospital complications were more strongly associated with readmission after trauma than injury characteristics. Improved social support and follow-up after discharge for high-risk patients may facilitate earlier identification of postdischarge complications.
Authors: Jennifer Bath; Daniel Freeman; Mariana Salamoun; Ellen Harvey; Andrea Wright; Mark Hamill; Daniel Lollar; Katie Love Bower; Bryan Collier Journal: J Trauma Nurs Date: 2019 Jan/Feb Impact factor: 1.010
Authors: Francesco Napolitano; Davide Tomassoni; Diana Cascone; Gabriella Di Giuseppe Journal: Eur J Public Health Date: 2018-06-01 Impact factor: 3.367
Authors: Amol S Navathe; Feiran Zhong; Victor J Lei; Frank Y Chang; Margarita Sordo; Maxim Topaz; Shamkant B Navathe; Roberto A Rocha; Li Zhou Journal: Health Serv Res Date: 2017-03-13 Impact factor: 3.402
Authors: Erin C Hall; Rebecca L Tyrrell; Karen E Doyle; Thomas M Scalea; Deborah M Stein Journal: J Trauma Acute Care Surg Date: 2018-05 Impact factor: 3.313
Authors: Lynne Moore; Henry Thomas Stelfox; Alexis F Turgeon; Avery B Nathens; André Lavoie; Gilles Bourgeois; Jean Lapointe Journal: J Trauma Acute Care Surg Date: 2014-05 Impact factor: 3.313
Authors: 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 Journal: J Trauma Acute Care Surg Date: 2019-07 Impact factor: 3.313