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Risk factors for unplanned readmissions in older adult trauma patients in Washington State: a competing risk analysis. J Am Coll Surg 2015 Mar;220(3):330-8

Date

12/30/2014

Pubmed ID

25542280

DOI

10.1016/j.jamcollsurg.2014.11.012

Scopus ID

2-s2.0-84923259845   27 Citations

Abstract

BACKGROUND: Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readmissions and identify the most common readmission diagnoses among these patients.

STUDY DESIGN: We conducted a retrospective cohort study of trauma patients age 55 years and older who survived their hospitalization at a statewide trauma center between 2009 and 2010. Linking 3 statewide databases, nonelective readmission rates were calculated for 30 days, 6 months, and 1 year after index discharge. Competing risk regression was used to determine risk factors for readmission and account for the competing risk of dying without first being readmitted. Subhazard ratios (SHR) are reported, indicating the relative risk of readmission by 30 days, 6 months, and 1 year.

RESULTS: The cumulative readmission rates for the 14,536 participants were 7.9%, 18.9%, and 25.2% at 30 days, 6 months, and 1 year, respectively. In multivariable models, the strongest risk factors for readmission at 1 year (based on magnitude of SHR) were severe head injury (adjusted SHR = 1.47; 95% CI, 1.24-1.73) and disposition to a skilled nursing facility (SHR = 1.54; 95% CI, 1.39-1.71). The diagnoses most commonly associated with readmission were atrial fibrillation, anemia, and congestive heart failure.

CONCLUSIONS: In this statewide study, unplanned readmissions after older adult trauma occurred frequently up to 1 year after discharge, particularly for patients who sustained severe head trauma and who could not be discharged home independently. Examining common readmission diagnoses might inform the development of interventions to prevent unplanned readmissions.

Author List

Fawcett VJ, Flynn-O'Brien KT, Shorter Z, Davidson GH, Bulger E, Rivara FP, Arbabi S

Author

Katherine T. Flynn-O'Brien MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Middle Aged
Multivariate Analysis
Patient Readmission
Regression Analysis
Retrospective Studies
Risk Assessment
Risk Factors
Washington
Wounds and Injuries