• Injury · Aug 2016

    Unplanned 30-day readmissions in orthopaedic trauma.

    • David Metcalfe, Olubode A Olufajo, Cheryl K Zogg, Arturo Rios-Diaz, Mitchel Harris, Michael J Weaver, Adil H Haider, and Ali Salim.
    • Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK; Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA. Electronic address: david.metcalfe@ndorms.ox.ac.uk.
    • Injury. 2016 Aug 1; 47 (8): 1794-7.

    Introduction30-day readmission is increasingly used as a hospital quality metric. The objective of this study was to describe the patient factors associated with unplanned 30-day hospital readmission of orthopaedic trauma patients.MethodsA statewide observational study was undertaken using data from all acute hospitals in California. All hospital inpatients with a primary diagnosis of fracture or dislocation (ICD-9-CM codes 800-829) were included, except for those with isolated injuries to the skull, face, or ribs. The primary outcome measure was unplanned 30-day readmission to any hospital in California.Results416,568 trauma admissions were available for analysis. The overall readmission rate was 6.5%, and 27.3% of readmitted patients presented to a different hospital. Factors significantly associated with readmission were male sex (OR 1.23, 95% CI 1.19-1.27), age 46-65 (2.61 [2.27-2.99]), black race (1.19 [1.11-1.27]), entitlement to publicly funded healthcare (1.38 [1.25-1.52]), Charlson Comorbidity Index ≥2 (1.84 [1.79-1.90]), discharge against medical advice (3.13 [2.67-3.68]), and spinal fracture (1.42 [1.34-1.49]). Major reasons for readmission included: cardiopulmonary disease (25.6%), infections (20.1%), musculoskeletal problems (18.1%), and procedural complications (12.0%).ConclusionsMany orthopaedic trauma readmissions are potentially unrelated to the initial hospitalization. Penalties for unplanned readmissions risk penalizing hospitals that serve disadvantaged communities and treat a high proportion of trauma patients.Copyright © 2016 Elsevier Ltd. All rights reserved.

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