Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Unplanned readmission after traumatic injury

A long-term nationwide analysis

Lunardi, Nicole MSPH; Mehta, Ambar MD, MPH; Ezzeddine, Hiba MD; Varma, Sanskriti; Winfield, Robert D. MD; Kent, Alistair MD; Canner, Joseph K. MHS; Nathens, Avery B. MD, MPH, PhD; Joseph, Bellal A. MD; Efron, David T. MD; Sakran, Joseph V. MD, MPA, MPH

Journal of Trauma and Acute Care Surgery: July 2019 - Volume 87 - Issue 1 - p 188–194
doi: 10.1097/TA.0000000000002339

BACKGROUND Long-term outcomes after trauma admissions remain understudied. We analyzed the characteristics of inpatient readmissions within 6 months of an index hospitalization for traumatic injury.

METHODS Using the 2010 to 2015 Nationwide Readmissions Database, which captures data from up to 27 US states, we identified patients at least 15 years old admitted to a hospital through an emergency department for blunt trauma, penetrating trauma, or burns. Exclusion criteria included hospital transfers, patients who died during their index hospitalizations, and hospitals with fewer than 100 trauma patients annually. After calculating the incidences of all-cause, unplanned inpatient readmissions within 1 month, 3 months, and 6 months, we used multivariable logistic regression models to identify predictors of readmissions. Analyses adjusted for patient, clinical, and hospital factors.

RESULTS Among 2,763,890 trauma patients, the majority had blunt injuries (92.5%), followed by penetrating injuries (6.2%) and burns (1.5%). Overall, rates of inpatient readmissions were 11.1% within 1 month, 21.6% within 6 months, and 29.8% within 6 months, with limited variability by year. After adjustment, the following were associated with all-cause 6 months inpatient readmissions: male sex (adjusted odds ratio [aOR], 1.10; 95% confidence interval [95% CI], 1.09–1.10), comorbidities (aOR, 1.21; 95% CI, 1.21–1.22), low-income quartiles (first and second) (aOR, 1.08; 95% CI, 1.07–1.10 and aOR, 1.04; 95% CI, 1.03–1.06, respectively), Medicare (aOR, 1.65; 95% CI, 1.62–1.69), Medicaid (aOR, 1.51; 95% CI, 1.48–1.53), being treated at private, investor-owned hospitals (aOR, 1.15; 95% CI, 1.12–1.18), longer hospital length of stay (aOR, 1.01; 95% CI, 1.01–1.01) and patient disposition to short-term hospital (aOR, 1.55; 95% CI, 1.49–1.62), skilled nursing facility (aOR, 1.43; 95% CI, 1.42–1.45), home health care (aOR, 1.27; 95% CI, 1.25–1.28), or leaving against medical advice (aOR, 1.85; 95% CI, 1.78–1.92).

CONCLUSION Unplanned readmission after trauma is high and remains this way 6 months after discharge. Understanding the factors that increase the odds of readmissions within 1 month, 3 months, and 6 months offer a focus for quality improvement and have important implications for hospital benchmarking.

LEVEL OF EVIDENCE Epidemiological study, level III.

From the School of Medicine, Johns Hopkins University (N.L., S.V.), Baltimore, Maryland; Department of Surgery (A.M.), New York-Presbyterian Columbia University Medical Center, New York, New York; Department of Surgery (H.E., A.K., J.K.C., D.T.E., J.V.S.), Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery (R.D.W.), Kentucky University Medical Center, Lexington, Kentucky; Department of Surgery (A.B.N.), University of Toronto, Toronto, ON, Canada; and Department of Surgery, University of Arizona College of Medicine (B.A.J.), Tucson, Arizona.

Submitted: November 29, 2018, Revised: February 25, 2019, Accepted: March 20, 2019, Published online: April 26, 2019.

32nd Annual Meeting of EAST AAST and Clinical Congress of Acute Care Surgery, January, 15-19, 2019, in Austin, TX.

Address for reprints: Joseph V. Sakran, MD, Division of Acute Care Surgery, Department of Surgery, Sheikh Zayed Tower, Suite 6107, Baltimore, MD 21287; email:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Online date: April 30, 2019

© 2019 Lippincott Williams & Wilkins, Inc.