Association of Psychosocial Factors and Hospital Complications with Risk for Readmission After Trauma.
Association of Psychosocial Factors and Hospital Complications with Risk for Readmission After Trauma.
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DOI：
10.1016/j.jss.2021.02.031
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Rivara FP
中科院分区：
文献类型：
--
作者：
Killien EY;Huijsmans RLN;Vavilala MS;Schleyer AM;Robinson EF;Maine RG;Rivara FP
计划外的再入院与发病率和高费用有关。现有的关于创伤后再入院的文献主要集中在损伤特征与再入院的关系上。我们的目的是评估健康的社会心理决定因素和住院并发症结合损伤特征如何影响创伤后再入院的风险。我们对2015年7月至2017年9月在华盛顿州西雅图港景医疗中心（Harborview Medical Center）住院的成人创伤患者进行了回顾性队列研究。我们使用多变量广义线性泊松回归模型评估了患者、损伤和住院特征，并估计了危险因素与意外30天再入院之间的关联。在8916例外伤出院患者中，330例（3.7%）有计划外30天再入院。再入院患者最常见的是感染（41.5%）。术后患者再入院的独立危险因素包括公共保险（调整相对危险度（aRR） 1.34, 95% CI 1.02-1.76）、精神疾病（aRR 1.39, 1.04-1.85）和慢性肾功能衰竭（aRR 2.17, 1.39 - 3.39）；接受腹部、胸部或神经外科手术的；发生住院手术部位感染（aRR 4.74, 3.00-7.50）、肺栓塞（aRR 3.38, 2.04-5.60）或计划外的ICU再入院（aRR 1.74, 1.16-2.62）；缩短住院时间（0.98里亚尔/天，0.97-0.99里亚尔），并将其送往监狱（4.68里亚尔，2.63-8.35里亚尔）或收容所（4.32里亚尔，2.58-7.21里亚尔）。危险因素因再入院原因而异。损伤严重程度、创伤机制和身体部位与再入院风险无独立相关性。心理社会因素和医院并发症与创伤后再入院的关系比损伤特征更密切。改善高危患者的社会支持和出院后随访可能有助于及早发现出院后并发症。
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. We conducted a retrospective cohort study of adult trauma admissions from 7/2015–9/2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-day readmission using multivariable generalized linear Poisson regression models. Of 8,916 discharged trauma patients, 330 (3.7%) had an unplanned 30-day readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among post-operative 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/day, 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. 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 post-discharge complications.
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