Institutional members access full text with Ovid®

Rates, Patterns, and Determinants of Unplanned Readmission After Traumatic Injury: A Multicenter Cohort Study

Moore, Lynne PhD*,†; Stelfox, Henry Thomas MD, MSc, FRCPC; Turgeon, Alexis F. MD, MSc, FRCPC*,§; Nathens, Avery B. MD, PhD; Le Sage, Natalie MD, MSc; Émond, Marcel MD, MSc; Bourgeois, Gilles MD; Lapointe, Jean MD; Gagné, Mathieu MSc*

doi: 10.1097/SLA.0b013e31828b0fae
Original Articles

Objective: This study aimed to (i) describe unplanned readmission rates after injury according to time, reason, and place; (ii) compare observed rates with general population rates, and (iii) identify determinants of 30-day readmission.

Background: Hospital readmissions represent an important burden in terms of mortality, morbidity, and resource use but information on unplanned rehospitalization after injury admissions is scarce.

Methods: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian provincial trauma system (1998–2010; n = 115,329). Trauma registry data were linked to hospital discharge data to obtain information on readmission up to 12 months postdischarge. Provincial admission rates were matched to study data by age and gender to obtain expected rates. Determinants of readmission were identified using multiple logistic regression.

Results: Cumulative readmission rates at 30 days, 3 months, 6 months, and 12 months were 5.9%, 10.9%, 15.5%, and 21.1%, respectively. Observed rates persisted above expected rates up to 11 months postdischarge. Thirty percent of 30-day readmissions were due to potential complications of injury compared with 3% for general provincial admissions. Only 23% of readmissions were to the same hospital. The strongest independent predictors of readmission were the number of prior admissions, discharge destination, the number of comorbidities, and age.

Conclusions: Unplanned readmissions after discharge from acute care for traumatic injury are frequent, persist beyond 30 days, and are often related to potential complications of injury. Several patient-, injury-, and hospital-related factors are associated with the risk of readmission. Injury readmission rates should be monitored as part of trauma quality assurance efforts.

Unplanned hospital readmission is a major burden in terms of mortality, morbidity, and costs, but little is known about rehospitalization after traumatic injury. This multicenter retrospective cohort study describes the patterns, rates, and determinants of unplanned readmission in patients admitted for trauma. Results suggest that unplanned readmissions in this population are frequent, persist beyond 30 days, and are often related to potential complications of injury.

*Department of Social and Preventative Medicine, Université Laval, Québec, Canada

Unité de traumatologie-urgence-soins intensifs, CHU de Québec - H^opital Enfant-Jésus, Université Laval, Québec, Canada

Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), University of Calgary, Calgary, Alberta, Canada

§Department of Anesthesiology, Division of Critical Care Medicine, Université laval, Québec, Québec, Canada

Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and

Institut national d'excellence en santé et en services sociaux, Montréal, Québec, Canada.

Reprints: Lynne Moore, PhD, CHU de Québec - H^opital Enfant-Jésus, Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine Unit), 1401, 18e rue, local H-012a, QC G1J 1Z4, Canada. E-mail: lynne.moore.cha@ssss.gouv.qc.ca.

Disclosure: This study was supported by Canadian Institutes of Health Research: young investigator award (H.T.S. and L.M.) and research grant no. 110996 (L.M.); Fonds de la recherche du Québec-Santé: clinician-scientist award (A.F.T.). The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2014 by Lippincott Williams & Wilkins.