Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US.

Autor:	Hernandez J; General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA., Spector CL; General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA., Quintero LA; General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA., Shatawi Z; General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA., Rosenthal A; Trauma Critical Care Surgery, Florida Atlantic University, Hollywood, FL, USA., Curcio G; Trauma Critical Care Surgery, University of South Florida, Fort Pierce, FL, USA., Buicko JL; Endocrine, Breast, and General Surgery, Florida Atlantic University, Boynton Beach, FL, USA., Parreco JP; Trauma Critical Care Surgery, Florida Atlantic University, Hollywood, FL, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Jul; Vol. 89 (7), pp. 3140-3144. Date of Electronic Publication: 2023 Mar 02.
DOI:	10.1177/00031348231160818
Abstrakt:	Background: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. Material and Methods: The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years. The primary outcome was mortality; secondary outcomes were prolonged length of stay (LOS) greater than 30 days, readmission within 30 days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome. Results: 157 945 patients were included with 11.0% (n = 17 346) admitted to investor-owned hospitals. The overall mortality rate and prolonged LOS were similar for both groups. The overall readmission rate was 9.2% (n = 13 895), with the rate in investor-owned hospitals at 10.5% (n = 1,739, P < .001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] P < .001) and readmission to a different hospital (OR 1.3 [1.2-1.5] P < .001). Discussion: Severely injured trauma patients have similar rates of mortality and prolonged length of stay in investor-owned vs public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to improve outcomes after trauma must consider hospital ownership and readmission to different hospitals.
Databáze:	MEDLINE
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