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Readmission rates and associated factors following rib cage injury

Baker, Jennifer E. MD; Skinner, Mitchell BS; Heh, Victor PhD; Pritts, Timothy A. MD, PhD; Goodman, Michael D. MD; Millar, D. Anderson MD; Janowak, Christopher F. MD

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1269–1276
doi: 10.1097/TA.0000000000002390

BACKGROUND There remains a lack of knowledge about readmission characteristics after sustaining rib fractures. We aimed to determine rates, characteristics, and predictive/protective factors associated with unexpected reevaluation and readmission after rib cage injury.

METHODS A retrospective review was performed based on trauma patients evaluated at an urban Level I trauma center from January 2014 to December 2016. Adult patients sustaining blunt trauma with more than one rib fracture or a sternomanubrial fracture were defined as having moderate to severe rib cage injury. Exclusion criteria included penetrating injury, death during initial hospitalization, and only one rib fracture. Reevaluation was defined as presenting at a hospital within 90 days of discharge urgently or emergently. Demographics, injury characteristics, comorbidities, complications, imaging, and readmission data were collected. Univariate and multivariate analysis was performed with a significance of p less than 0.05.

RESULTS During the study period, 11,667 patients underwent trauma evaluation, of which 1,717 patients were found to have a moderate to severe rib cage injury. Within 90 days, 397 (23.1%) of patients underwent reevaluation, while 177 (10.3%) required readmission. One hundred forty-two (8.3%) patients were reevaluated specifically for chest-related complaints, and 55 (3.2%) required readmission. On univariate analysis, Injury Severity Score greater than 15, hospital length of stay longer than 7 days, intensive care unit (ICU) length of stay longer than 3 days, a worsened chest x-ray at discharge, a psychiatric comorbidity, a smoking comorbidity, deep vein thrombosis, unplanned readmission to the ICU, and unplanned intubation were higher in the overall reevaluation cohort. On multivariate analysis, age of 15 years to 35 years, Risk Assessment Profile score greater than 8, hypertension, psychiatric comorbidity, current smoker, and unplanned return to the ICU on index admission were predictive of reevaluation of overall reevaluation.

CONCLUSION Moderate to severe rib cage injury is associated with high rates of reevaluation and readmission. Younger patients who smoke and required a return to the ICU are at greater risk for readmission.

LEVEL OF EVIDENCE Level IV, Prognostic and Epidemiologic.

From the Section of General Surgery, Divisions of Trauma and General Surgery Research, Department of Surgery (J.E.B., M.S., V.H., T.A.P., M.D.G., D.A.M., C.F.J.), University of Cincinnati, Cincinnati, Ohio.

Submitted: May 9, 2019, Accepted: May 9, 2019, Published online: June 12, 2019.

Address for reprints: Christopher Janowak, MD, University of Cincinnati Department of Surgery, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267-0558; email:

Presented at the 2019 Chest Wall Injury Summit, March 28-30, Santa Fe, NM.

Online date: June 13, 2019

© 2019 Lippincott Williams & Wilkins, Inc.