Unplanned 30-day readmissions in orthopaedic trauma.
BACKGROUND
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.
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.
David
D
Metcalfe
Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
Olubode A
OA
Olufajo
Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
Cheryl K
CK
Zogg
Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
Arturo
A
Rios-Diaz
Department of Orthopedic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Mitchel
M
Harris
Department of Orthopedic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Michael J
MJ
Weaver
Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
Adil H
AH
Haider
Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
Ali
A
Salim
D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult
Orthopaedic trauma; Readmission