Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Res. 2020 Jun;250:209-215. doi: 10.1016/j.jss.2019.12.027. Epub 2020 Feb 21.
Unplanned readmissions of surgical patients are associated with increased morbidity and mortality. "Fragmentation of care" (FOC) occurs when patients are readmitted to a different hospital than where they initially received care. FOC complicates accurate quantification of hospital readmission rates and is associated with worse outcomes in many surgical patient populations. However, few studies have evaluated the impact of FOC specifically on patients with traumatic injury.
We performed a retrospective cohort study using the 2013 National Readmissions Database. Data on demographics, diagnosis, injury severity, readmissions, complications, and outcomes were collected. Patients readmitted to hospitals within 30 d after index admission were identified, and risk factors for readmission were discerned. Patients were stratified into groups readmitted to index versus nonindex hospital. Outcomes were compared between these groups.
A total of 333,188 patients with index admission for injury were identified; 34,197 (10.3%) were readmitted within 30 d of discharge. Of these, only 24,747 (72.4%) were readmitted to their index hospital for an FOC rate of 27.6%. There was no significant difference in outcomes between patients readmitted to index versus nonindex hospitals. Among all readmitted patients, 30-d mortality was associated only with burden of medical comorbidities and age.
Single-institution readmission rates are not reflective of true readmission rates for trauma patients. FOC does not impact outcomes in trauma patients who are readmitted; however, age and number of comorbidities are associated with higher mortality in these patients. FOC rates are high in trauma patient populations and merit further investigation to determine potential etiologies and consequences.
手术患者的非计划性再入院与发病率和死亡率的增加有关。当患者被重新收治到与最初接受治疗的医院不同的医院时，就会发生“护理碎片化”（FOC）。FOC 使医院再入院率的准确量化变得复杂，并与许多外科患者群体的不良结局相关。然而，很少有研究专门评估 FOC 对创伤性损伤患者的影响。
我们使用 2013 年国家再入院数据库进行了回顾性队列研究。收集了人口统计学、诊断、损伤严重程度、再入院、并发症和结局的数据。确定了在指数入院后 30 天内被重新收治到医院的患者，并确定了再入院的风险因素。将患者分为重新收治到指数医院与非指数医院的组。比较了这些组之间的结局。
确定了 333188 名有指数入院的创伤患者；34197 名（10.3%）在出院后 30 天内再次入院。其中，只有 24747 名（72.4%）重新收治到他们的指数医院，FOC 率为 27.6%。在重新收治到指数医院与非指数医院的患者之间，结局没有显著差异。在所有重新收治的患者中，30 天死亡率仅与医疗合并症和年龄的负担有关。
单一机构的再入院率不能反映创伤患者的真实再入院率。FOC 不会影响重新收治的创伤患者的结局；然而，年龄和合并症数量与这些患者的更高死亡率相关。创伤患者群体的 FOC 率很高，值得进一步调查，以确定潜在的病因和后果。
