Predictors of care discontinuity in geriatric trauma patients.

Autor:	Castillo-Angeles M; From the Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (M.C.-A., S.L.N., R.A., Z.C., A.S., J.M.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery (M.C.-A., C.K.Z., M.P.J., Z.C., A.L., J.M.H.), Brigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery (C.K.Z.), Yale School of Medicine, New Haven, Connecticut., Zogg CK, Jarman MP, Nitzschke SL, Askari R, Cooper Z, Salim A, Havens JM
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2023 Jun 01; Vol. 94 (6), pp. 765-770. Date of Electronic Publication: 2023 Mar 21.
DOI:	10.1097/TA.0000000000003961
Abstrakt:	Background: Readmission to a non-index hospital, or care discontinuity, has been shown to have worse outcomes among surgical patients. Little is known about its effect on geriatric trauma patients. Our goal was to determine predictors of care discontinuity and to evaluate its effect on mortality in this geriatric population. Methods: This was a retrospective analysis of Medicare inpatient claims (2014-2015) of geriatric trauma patients. Care discontinuity was defined as readmission within 30 days to a non-index hospital. Demographic and clinical characteristics (including readmission diagnosis category) were collected. Multivariate logistic regression analysis was performed to identify predictors of care discontinuity and to assess its association with mortality. Results: We included 754,313 geriatric trauma patients. Mean age was 82.13 years (SD, 0.50 years), 68% were male and 91% were White. There were 21,615 (2.87%) readmitted within 30 days of discharge. Of these, 34% were readmitted to a non-index hospital. Overall 30-day mortality after readmission was 25%. In unadjusted analysis, readmission to index hospitals was more likely to be due to surgical infection, GI complaints, or cardiac/vascular complaints. After adjusted analysis, predictors of care discontinuity included readmission diagnoses, patient- and hospital-level factors. Care discontinuity was not associated with mortality (OR, 0.93; 95% confidence interval, 0.86-1.01). Conclusion: More than a third of geriatric trauma patients are readmitted to a non-index hospital, which is driven by readmission diagnosis, travel time and hospital characteristics. However, unlike other surgical settings, this care discontinuity is not associated with increased mortality. Further work is needed to understand the reasons for this and to determine which standardized processes of care can benefit this population. Level of Evidence: Prognostic and Epidemiological; Level IV. (Copyright © 2023 American Association for the Surgery of Trauma.)
Databáze:	MEDLINE
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