title: Early hospital readmission in the trauma population: are the risk factors different?
abstract: BACKGROUND
  Hospital readmission rates will soon impact Medicare reimbursements. While risk factors for readmission have been described for medical and elective surgical patients, little is known about their predictive value specifically in trauma patients.
  
  
  METHODS
  We retrospectively identified all admissions after trauma resuscitation to our urban level 1 trauma centre from 1/1/2004 to 8/31/2010. All patients discharged alive were included. Data collected included demographics, Injury Severity Score (ISS), and length of stay (LOS). We analyzed these index admissions for the development of complications that have previously been shown to be associated with readmission. Readmissions that occurred within 30 days of index admission were identified. Univariable and multivariable analyses were performed. p<0.05 was considered significant.
  
  
  RESULTS
  We identified 10,306 index admissions, with 447 (4.3%) early (within 30 days) readmissions. Mean ISS was 11.1 (SD 10.4). On multivariable analysis, African-American race (OR 1.3, p=0.009), pre-existing chronic obstructive pulmonary disease (COPD) (OR 1.5, p=0.02), and diabetes mellitus (OR 1.8, p<0.001) were associated with readmission, along with higher ISS (OR 1.01, p<0.001), ICU admission (OR 2.1, p<0.001), and increased LOS (OR 1.01, p<0.001). Among many in-hospital complications examined, only the development of surgical site infection (SSI) (OR 1.9, p=0.02) was associated with increased risk of readmission.
  
  
  CONCLUSIONS
  Trauma patients have a low risk of readmission. In contrast to elective surgical patients, the only modifiable risk factor for readmission in our trauma population was SSI. Other risk factors may present clinicians with opportunities for targeted interventions, such as proactive follow up or early phone contact. With future changes to health care policy, clinicians may have even greater motivation to prevent readmission.
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States. Electronic address: morris.david@mayo.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Morris
authors.forename: Jeff
authors.initials: J
authors.lastname: Rohrbach
authors.forename: Latha Mary Thanka
authors.initials: LM
authors.lastname: Sundaram
authors.forename: Seema
authors.initials: S
authors.lastname: Sonnad
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: Patrick
authors.initials: P
authors.lastname: Reilly
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Carrie
authors.initials: C
authors.lastname: Sims
mesh_terms: D000328:Adult; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology* / Q000628:therapy
keywords: Readmissions; Risk factors; Trauma