Hannah Tan, Seth A Battad, Caleb W Brown, Derek C Wenger, Alexis N Lacey, Jared M Lentchner, Michael A Zaskey, Sarah A King, Hannah E Collins, Lou M Smith, J Bracken Burns
{"title":"创伤患者30天内再入院的危险因素分析。","authors":"Hannah Tan, Seth A Battad, Caleb W Brown, Derek C Wenger, Alexis N Lacey, Jared M Lentchner, Michael A Zaskey, Sarah A King, Hannah E Collins, Lou M Smith, J Bracken Burns","doi":"10.1177/00031348251371213","DOIUrl":null,"url":null,"abstract":"<p><p>BackgroundUnplanned hospital readmissions within 30 days of discharge for trauma (UR-30) are associated with adverse outcomes but remain underexplored in trauma populations.MethodsThis study retrospectively reviewed 164 trauma patients at a Level I center during 2022-2023, analyzing demographics, comorbidities, injury severity, socioeconomic factors, medications, and hospital events. Propensity matching ensured comparability between 82 UR-30 and 82 patients not readmitted (NoReadmission-30).ResultsKey findings include median hospital length of stay (LOS) of 5 days for UR-30 vs 3 days for NoReadmission-30 (<i>P</i> = .022) and ICU LOS of 2 vs 0 days (<i>P</i> < .001), respectively. Final in-hospital hemoglobin was lower in UR-30 (10.7 vs 12; <i>P</i> = .014). Discharge home rates were lower for UR-30 (51.2% vs 69.5%; <i>P</i> = .017). Transfusion requirements significantly increased readmission risk, with UR-30 patients 6.7 times more likely to be readmitted. Significant comorbidities included smoking (<i>P</i> = .042), hyperlipidemia (<i>P</i> = .012), CHF (<i>P</i> = .013), substance use disorder (<i>P</i> = .043), and ≥3 comorbid diagnoses (<i>P</i> = .001). Most readmissions were for infections, neurological decline, and inadequate pain control. Discharge on anticoagulants (<i>P</i> = .007) or with ≥7 discharge medications (<i>P</i> < .001) increased readmission likelihood, while chronic NSAID use reduced it (<i>P</i> = .046). Family as PoA was more common in UR-30 (83% vs 40%; <i>P</i> < .001). Non-significant factors included discharge vital signs, injury mechanism, insurance, and race.DiscussionUR-30 occurs predominantly in moderately injured patients and is influenced by ICU and hospital LOS, discharge disposition, comorbidities, and transfusion status, underscoring its value as a trauma quality metric.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1862-1867"},"PeriodicalIF":0.9000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factor Analysis for Trauma Patients Readmitted Within 30 Days.\",\"authors\":\"Hannah Tan, Seth A Battad, Caleb W Brown, Derek C Wenger, Alexis N Lacey, Jared M Lentchner, Michael A Zaskey, Sarah A King, Hannah E Collins, Lou M Smith, J Bracken Burns\",\"doi\":\"10.1177/00031348251371213\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BackgroundUnplanned hospital readmissions within 30 days of discharge for trauma (UR-30) are associated with adverse outcomes but remain underexplored in trauma populations.MethodsThis study retrospectively reviewed 164 trauma patients at a Level I center during 2022-2023, analyzing demographics, comorbidities, injury severity, socioeconomic factors, medications, and hospital events. Propensity matching ensured comparability between 82 UR-30 and 82 patients not readmitted (NoReadmission-30).ResultsKey findings include median hospital length of stay (LOS) of 5 days for UR-30 vs 3 days for NoReadmission-30 (<i>P</i> = .022) and ICU LOS of 2 vs 0 days (<i>P</i> < .001), respectively. Final in-hospital hemoglobin was lower in UR-30 (10.7 vs 12; <i>P</i> = .014). Discharge home rates were lower for UR-30 (51.2% vs 69.5%; <i>P</i> = .017). Transfusion requirements significantly increased readmission risk, with UR-30 patients 6.7 times more likely to be readmitted. Significant comorbidities included smoking (<i>P</i> = .042), hyperlipidemia (<i>P</i> = .012), CHF (<i>P</i> = .013), substance use disorder (<i>P</i> = .043), and ≥3 comorbid diagnoses (<i>P</i> = .001). Most readmissions were for infections, neurological decline, and inadequate pain control. Discharge on anticoagulants (<i>P</i> = .007) or with ≥7 discharge medications (<i>P</i> < .001) increased readmission likelihood, while chronic NSAID use reduced it (<i>P</i> = .046). Family as PoA was more common in UR-30 (83% vs 40%; <i>P</i> < .001). Non-significant factors included discharge vital signs, injury mechanism, insurance, and race.DiscussionUR-30 occurs predominantly in moderately injured patients and is influenced by ICU and hospital LOS, discharge disposition, comorbidities, and transfusion status, underscoring its value as a trauma quality metric.</p>\",\"PeriodicalId\":7782,\"journal\":{\"name\":\"American Surgeon\",\"volume\":\" \",\"pages\":\"1862-1867\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2025-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Surgeon\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/00031348251371213\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/00031348251371213","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景创伤出院后30天内未计划再入院(UR-30)与不良后果相关,但在创伤人群中仍未得到充分研究。方法回顾性分析某一级中心2022-2023年收治的164例创伤患者,分析人口统计学、合并症、损伤严重程度、社会经济因素、药物治疗和医院事件。倾向匹配确保了82例UR-30和82例未再入院患者(noreadmission30)之间的可比性。结果UR-30组中位住院时间(LOS)为5天,无再入院-30组为3天(P = 0.022); ICU组中位住院时间(LOS)为2天,无再入院-30组为0天(P < 0.001)。UR-30患者最终住院血红蛋白较低(10.7 vs 12; P = 0.014)。UR-30患者出院回家率较低(51.2% vs 69.5%; P = 0.017)。输血要求显著增加再入院风险,UR-30患者再入院的可能性高出6.7倍。显著的合并症包括吸烟(P = 0.042)、高脂血症(P = 0.012)、心力衰竭(P = 0.013)、物质使用障碍(P = 0.043)和≥3个合并症诊断(P = 0.001)。大多数再入院的原因是感染、神经功能下降和疼痛控制不足。出院时使用抗凝剂(P = 0.007)或使用≥7种出院药物(P < 0.001)会增加再入院的可能性,而长期使用非甾体抗炎药会降低再入院的可能性(P = 0.046)。家族性PoA在UR-30患者中更为常见(83% vs 40%; P < 0.001)。非显著性因素包括出院生命体征、损伤机制、保险和种族。ur -30主要发生在中度损伤患者中,受ICU和医院LOS、出院处置、合并症和输血状况的影响,强调了其作为创伤质量指标的价值。
Risk Factor Analysis for Trauma Patients Readmitted Within 30 Days.
BackgroundUnplanned hospital readmissions within 30 days of discharge for trauma (UR-30) are associated with adverse outcomes but remain underexplored in trauma populations.MethodsThis study retrospectively reviewed 164 trauma patients at a Level I center during 2022-2023, analyzing demographics, comorbidities, injury severity, socioeconomic factors, medications, and hospital events. Propensity matching ensured comparability between 82 UR-30 and 82 patients not readmitted (NoReadmission-30).ResultsKey findings include median hospital length of stay (LOS) of 5 days for UR-30 vs 3 days for NoReadmission-30 (P = .022) and ICU LOS of 2 vs 0 days (P < .001), respectively. Final in-hospital hemoglobin was lower in UR-30 (10.7 vs 12; P = .014). Discharge home rates were lower for UR-30 (51.2% vs 69.5%; P = .017). Transfusion requirements significantly increased readmission risk, with UR-30 patients 6.7 times more likely to be readmitted. Significant comorbidities included smoking (P = .042), hyperlipidemia (P = .012), CHF (P = .013), substance use disorder (P = .043), and ≥3 comorbid diagnoses (P = .001). Most readmissions were for infections, neurological decline, and inadequate pain control. Discharge on anticoagulants (P = .007) or with ≥7 discharge medications (P < .001) increased readmission likelihood, while chronic NSAID use reduced it (P = .046). Family as PoA was more common in UR-30 (83% vs 40%; P < .001). Non-significant factors included discharge vital signs, injury mechanism, insurance, and race.DiscussionUR-30 occurs predominantly in moderately injured patients and is influenced by ICU and hospital LOS, discharge disposition, comorbidities, and transfusion status, underscoring its value as a trauma quality metric.
期刊介绍:
The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.