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Abstract
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BACKGROUND: Nearly 1-in-10 trauma patients in the U.S. are readmitted within 30 days of discharge, with a median hospital cost of over $8,000 per readmission. There are national efforts to reduce readmissions in trauma care, but we do not yet understand which are potentially preventable. Our study aims to quantify the Potentially Preventable Readmissions (PPRs) in trauma care to serve as the anchor point for ongoing efforts to curb hospital readmissions and ultimately, bring preventable readmissions to zero.
METHODS: We identified inpatient hospitalizations after trauma as well as readmissions within 90 days in the 2017 National Readmissions Database (NRD). PPRs were defined as the AHRQ-defined Ambulatory Care Sensitive Conditions, in addition to superficial surgical site infection, acute kidney injury/acute renal failure, and aspiration pneumonitis. Mean costs for these admissions were calculated using the NRD. A multivariable logistic regression model was utilized to characterize the relationship between patient characteristics and PPR.
RESULTS: 2,420,083 patients were admitted for trauma care in the 2017 NRD and 137,854 (10.4%) were readmitted within 90 days of discharge. Of these readmissions, 22.7% were potentially preventable. The mean cost was $10,001/PPR, resulting in $313,802,278 in cost to the US healthcare system. Of readmitted trauma patients <65 years old, Medicaid or Medicare patients had 2.7-fold increased odds of PPRs compared to privately insured patients. Patients of any age with congestive heart failure had 2.9x increased odds of PPR, those with COPD or complicated diabetes had 1.8x increased odds, and those with chronic kidney disease had 1.7x increased odds. Furthermore, as the days from discharge increased, the proportion of readmissions due to PPRs increased.
CONCLUSIONS: One-in-five trauma readmissions are potentially preventable, which account for over $300 million annually in healthcare costs. Improved access to post-discharge ambulatory care may be key to minimizing PPRs, especially for those with certain comorbidities. LEVEL OF EVIDENCE: Level II, Economic & Value-Based Evaluations.
Language: en |