Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.
Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; University Medical Center Utrecht, Utrecht, Netherlands.
J Surg Res. 2021 Aug;264:334-345. doi: 10.1016/j.jss.2021.02.031. Epub 2021 Apr 10.
Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affect risk of readmission after trauma.
We conducted a retrospective cohort study of adult trauma admissions from July 2015 to September 2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-d readmission using multivariable generalized linear Poisson regression models.
Of 8916 discharged trauma patients, 330 (3.7%) had an unplanned 30-d readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among postoperative patients included public insurance (adjusted Relative Risk (aRR) 1.34, 95% CI 1.02-1.76), mental illness (aRR 1.39, 1.04-1.85), and chronic renal failure (aRR 2.17, 1.39-3.39); undergoing abdominal, thoracic, or neurosurgical procedures; experiencing an index hospitalization surgical site infection (aRR 4.74, 3.00-7.50), pulmonary embolism (aRR 3.38, 2.04-5.60), or unplanned ICU readmission (aRR 1.74, 1.16-2.62); shorter hospital stay (aRR 0.98/d, 0.97-0.99), and discharge to jail (aRR 4.68, 2.63-8.35) or a shelter (aRR 4.32, 2.58-7.21). Risk factors varied by reason for readmission. Injury severity, trauma mechanism, and body region were not independently associated with readmission risk.
Psychosocial factors and hospital complications were more strongly associated with readmission after trauma than injury characteristics. Improved social support and follow-up after discharge for high-risk patients may facilitate earlier identification of postdischarge complications.
非计划性医院再入院与发病率和高成本有关。现有的创伤后再入院文献主要关注的是损伤特征与再入院的关系。我们旨在评估健康的社会心理决定因素和住院并发症与损伤特征相结合如何影响创伤后的再入院风险。
我们对 2015 年 7 月至 2017 年 9 月期间华盛顿州西雅图港景医疗中心收治的成年创伤患者进行了回顾性队列研究。我们评估了患者、损伤和住院情况，并使用多变量广义线性泊松回归模型估计了危险因素与非计划性 30 天再入院之间的关系。
在 8916 名出院的创伤患者中，有 330 名（3.7%）发生了非计划性 30 天再入院。再入院的患者最常见的原因是感染（41.5%）。术后患者再入院的独立危险因素包括公共保险（调整后的相对风险[aRR]1.34，95%可信区间[CI]1.02-1.76）、精神疾病（aRR 1.39，1.04-1.85）和慢性肾衰竭（aRR 2.17，1.39-3.39）；接受腹部、胸部或神经外科手术；经历索引住院手术部位感染（aRR 4.74，3.00-7.50）、肺栓塞（aRR 3.38，2.04-5.60）或非计划性 ICU 再入院（aRR 1.74，1.16-2.62）；住院时间较短（aRR 0.98/d，0.97-0.99），出院至监狱（aRR 4.68，2.63-8.35）或收容所（aRR 4.32，2.58-7.21）。危险因素因再入院原因而异。损伤严重程度、创伤机制和身体部位与再入院风险无独立相关性。
与损伤特征相比，社会心理因素和医院并发症与创伤后再入院的关系更为密切。为高风险患者提供更好的社会支持和出院后随访，可能有助于更早发现出院后并发症。
