Association of Psychosocial Factors and Hospital Complications with Risk for Readmission after Trauma
| Autor: | Roel Huijsmans, Rebecca G. Maine, Anneliese M. Schleyer, Elizabeth Y Killien, Ellen Robinson, Frederick P. Rivara, Monica S. Vavilala |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Social Determinants of Health Aftercare Patient Readmission Risk Assessment Article 03 medical and health sciences Social support symbols.namesake 0302 clinical medicine Postoperative Complications Trauma Centers Risk Factors Medicine Humans Social determinants of health Poisson regression Aged Retrospective Studies business.industry Retrospective cohort study Length of Stay Middle Aged medicine.disease Pulmonary embolism Intensive Care Units 030220 oncology & carcinogenesis Relative risk Surgical Procedures Operative Emergency medicine symbols Wounds and Injuries 030211 gastroenterology & hepatology Surgery Body region Female business Psychosocial |
| Zdroj: | J Surg Res |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|