title: Repeat hospitalization and mortality in older adult burn patients.
abstract: The aim of this study was to examine 2-year postdischarge outcomes-including hospital readmissions, complications, and mortality-for a cohort of older adults with burn injury. In a statewide hospital discharge database, we identified all patients ≥ 45 years of age admitted for acute burn injury from 1996 to 2005 and followed each patient for any hospital admissions 2 years following discharge. We then linked the state database to the National Death Index to identify patients who died within the 2-year period. Kaplan-Meier survival functions estimated proportion of patients who died or were readmitted. Logistic regression was used to estimate mortality risk at 2 years for each age group. A total of 2573 patients were admitted with burn injuries, and 2388 (93%) survived to discharge. Of all index patients, 1077 (45%) had at least one rehospitalization, with those in the older age groups having more rehospitalizations. Of patients rehospitalized within 30 days, 25% were admitted for wound coverage or burn infection, 14% for rehabilitation, 10% for sepsis, and 9% for psychiatric reasons. Compared to those discharged home, more patients discharged to nursing facilities had ≥ 1 rehospitalization (71.5 vs 31.5%, P < .001). Survival progressively decreased by age category throughout the follow-up period. Compared with patients aged 45 to 54 years, the older age groups had increased mortality risk at 2 years: odds ratio (OR) 1.53 (95% confidence interval, 1.22-1.88) for the 55 to 64 years group, OR 2.51 (95% confidence interval, 2.03-3.09) for the 65 to 74 years group, and OR 2.90 (95% confidence interval, 2.36-3.55) for the ≥ 75 years group. This population-based study indicates that older patients have a high likelihood of rehospitalization and increased long-term mortality.
authors.affiliation: Department of Surgery, University of Washington Burn Center, Harborview Medical Center, Seattle Washington 98195, USA.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Mandell
authors.forename: Tam
authors.initials: T
authors.lastname: Pham
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000367:Age Factors; D000368:Aged; D002056:Burns / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014861:Washington / Q000453:epidemiology