Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Section of Plastic & Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL 60637, USA.
J Burn Care Res. 2024 May 6;45(3):709-718. doi: 10.1093/jbcr/irae020.
Older adults with burn injuries have a high risk of readmission after the initial burn admission. Frailty is associated with poor outcomes from the initial burn injury, however, it remains unknown if frailty impacts readmission in older adults after the initial index burn admission. Our study aims to examine patient, frailty, burn, surgical, and hospital factors that contribute to 90-day readmissions in older adults with an acute burn. Patients ≥ 50 years of age with an acute burn diagnosis in the Nationwide Readmissions Database (2016-2018) were included. Patients who died during index admissions were excluded from the readmission analysis. Patient, burn, hospital stay, and hospital characteristics were analyzed. Using variables significant from univariate logistic regression analysis, we performed a multivariable logistic regression analysis to identify factors associated with 90-day readmissions. A total of 41,500 weighted index burn admissions were included. The 90-day readmission rate was 25.6% (10,641/41,500). Almost all the readmissions were unplanned (96.5%). The most common primary readmission diagnoses based on Clinical Classifications Software Refined were burn injury and septicemia. Multivariable logistic regression analysis demonstrated an increased hospital frailty risk and lower-body-only burns were associated with an increased risk of readmission. Notably, surgical treatment of the burn injury during the index admission was associated with a decreased risk of readmission. This highlights the importance and challenges of surgical decision-making for older adults with high comorbidity burden. Future studies are needed to develop decision guides to help clinicians identify patients who would benefit from surgical treatment versus more conservative strategies in older adult patients with burns.
老年人烧伤后初始烧伤入院后再入院的风险较高。虚弱与初始烧伤损伤的不良结局相关，但尚不清楚虚弱是否会影响初始索引烧伤入院后老年人的再入院。我们的研究旨在检查导致老年急性烧伤患者 90 天再入院的患者、虚弱、烧伤、手术和医院相关因素。纳入了全国再入院数据库（2016-2018 年）中年龄≥50 岁且急性烧伤诊断的患者。从索引入院期间死亡的患者被排除在再入院分析之外。分析了患者、烧伤、住院时间和医院特征。使用单变量逻辑回归分析中显著的变量，我们进行了多变量逻辑回归分析，以确定与 90 天再入院相关的因素。共纳入 41500 例加权指数烧伤入院患者。90 天再入院率为 25.6%（10641/41500）。几乎所有的再入院都是非计划性的（96.5%）。根据临床分类软件精炼，最常见的主要再入院诊断是烧伤损伤和败血症。多变量逻辑回归分析表明，医院虚弱风险增加和下肢烧伤仅与再入院风险增加相关。值得注意的是，指数入院期间烧伤的手术治疗与再入院风险降低相关。这凸显了对高合并症负担的老年患者进行手术决策的重要性和挑战。需要进一步研究来制定决策指南，以帮助临床医生识别哪些患者将从手术治疗中受益，哪些患者将从更保守的策略中受益。
