title: The surgical revolving door: risk factors for hospital readmission.
abstract: BACKGROUND
  Unplanned hospital readmissions increase healthcare costs and patient morbidity. We sought to identify risk factors associated with early readmission in surgical patients.
  
  
  METHODS
  All admissions from a mixed surgical unit during 2009 were retrospectively reviewed and unplanned readmissions within 30 d of discharge were identified. Demographic data, length of stay, pre-existing diagnoses, and complications during the index admission were evaluated. T-tests and Fisher exact tests were used to examine the relationship of independent variables with readmission. Univariate and multivariate regression analysis were performed.
  
  
  RESULTS
  A total of 1808 index admissions occurred during the study period. In all, 51 (3%) patients were readmitted within 30 d of discharge. The majority of readmissions (53%) were for infectious reasons. On univariate analyses, DVT (P = 0.004) and acute renal failure (P = 0.002) were associated with increased risk of readmission. Readmitted patients were also more likely to have public insurance (63% versus 37%, P = 0.03) and have a longer stay in the hospital (8 d, range 4-14 d versus 3 d, range 2-7 d, P = 0.001). Initial admission after trauma evaluation was associated with a decreased risk of readmission (OR 0.374, P = 0.004). Other demographic variables and pre-existing conditions were not associated with increased readmission. On multivariate logistic regression only DVT (P = 0.039) and LOS (P = 0.014) remained significant.
  
  
  CONCLUSIONS
  Increased LOS and the development of a DVT are risk factors for early unplanned hospital readmission. Admission following trauma is associated with a decreased risk of readmission, possibly due to proactive multidisciplinary discharge planning and geographically-based nurse practitioner involvement.
authors.affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Hospital of the University of Pennsylvania. Philadelphia, Pennsylvania 19104, USA. david.morris2@uphs.upenn.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Morris
authors.forename: Jeff
authors.initials: J
authors.lastname: Rohrbach
authors.forename: Mary
authors.initials: M
authors.lastname: Rogers
authors.forename: Latha Mary
authors.initials: LM
authors.lastname: Thanka Sundaram
authors.forename: Seema
authors.initials: S
authors.lastname: Sonnad
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Patrick
authors.initials: P
authors.lastname: Reilly
authors.forename: Carrie
authors.initials: C
authors.lastname: Sims
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult