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. 2021 Aug:264:334-345.
doi: 10.1016/j.jss.2021.02.031. Epub 2021 Apr 10.

Association of Psychosocial Factors and Hospital Complications with Risk for Readmission After Trauma

Elizabeth Y Killien  1 , Roel L N Huijsmans  2 , Monica S Vavilala  3 , Anneliese M Schleyer  4 , Ellen F Robinson  5 , Rebecca G Maine  6 , Frederick P Rivara  7
Affiliations

Association of Psychosocial Factors and Hospital Complications with Risk for Readmission After Trauma

Elizabeth Y Killien et al. J Surg Res. 2021 Aug.

Abstract

Background: Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affect risk of readmission after trauma.

Materials and methods: We conducted a retrospective cohort study of adult trauma admissions from July 2015 to September 2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-d readmission using multivariable generalized linear Poisson regression models.

Results: Of 8916 discharged trauma patients, 330 (3.7%) had an unplanned 30-d readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among postoperative patients included public insurance (adjusted Relative Risk (aRR) 1.34, 95% CI 1.02-1.76), mental illness (aRR 1.39, 1.04-1.85), and chronic renal failure (aRR 2.17, 1.39-3.39); undergoing abdominal, thoracic, or neurosurgical procedures; experiencing an index hospitalization surgical site infection (aRR 4.74, 3.00-7.50), pulmonary embolism (aRR 3.38, 2.04-5.60), or unplanned ICU readmission (aRR 1.74, 1.16-2.62); shorter hospital stay (aRR 0.98/d, 0.97-0.99), and discharge to jail (aRR 4.68, 2.63-8.35) or a shelter (aRR 4.32, 2.58-7.21). Risk factors varied by reason for readmission. Injury severity, trauma mechanism, and body region were not independently associated with readmission risk.

Conclusions: Psychosocial factors and hospital complications were more strongly associated with readmission after trauma than injury characteristics. Improved social support and follow-up after discharge for high-risk patients may facilitate earlier identification of postdischarge complications.

Keywords: Patient readmission; risk factors; social determinants of health; trauma centers.

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Conflict of interest statement

Conflicts of Interest: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Figures

Figure 1:
Figure 1:
Reasons for 30-day hospital readmission after trauma by diagnostic category and specific diagnosis within each category. Median time (IQR) from discharge to readmission is indicated for each diagnosis.
Figure 2:
Figure 2:
Frequency and reason for readmission by patient age group (A), primary surgical procedure performed (B), hospital complications (C), and discharge disposition (D).
See this image and copyright information in PMC

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