Abstract
Abstract
Introduction
The purpose of this study was to identify risk factors and costs associated with readmission after burn injury across the United States.
Methods
The 2010–2014 Nationwide Readmissions Database was queried for patients admitted for burn. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. Readmission cost was calculated using cost-to-charge ratios.
Results
Of the 94,759 patients admitted with a burn, 7.4% (n=7000) were readmitted within 30 days and of those, 29.2% (n=2047) occurred at a different hospital. Infection (29.4% [n=1990]), graft loss, wound healing, late effects, or aftercare issues (15.3% [n=1074]), and pain control and/or hydration (19.2% [n=1346]) were the most common reasons for readmission. Risk factors unique to readmission to a different hospital include: second degree burns (OR 1.23, p<0.01) when compared to first and third degree burns, length of stay > 7 days (OR 2.07, p<0.01), and admission to a metropolitan teaching hospital (OR 1.50, p<0.01) compared to a metropolitan non-teaching hospital. Other risk factors for readmission to a different hospital included: burn of face, head and neck (OR 1.53, p<0.01) and admission to non-metropolitan hospital (OR 1.93, p<0.01). Compared to private insurance, Medicare and Medicaid patients were more likely to get readmitted to a different hospital (OR 1.29, p<0.01 and OR 1.21, p<0.049, respectively). Overall risk factors for readmission at 30 days included: depression (OR 1.30, p<0.01), psychoses (OR 1.53, p<0.01), burn of lower limbs (OR 1.29, p<0.01), third degree burns (OR 1.31, p<0.01), leaving against medical advice (OR 3.39, p<0.01), admission to for-profit hospital (OR 1.30, p<0.01), and Charlson Comorbidity Index ≥2 (OR 1.48, p<0.01). Further risk factors are presented in Table 1. The median readmission cost was higher for patients readmitted to a different hospital $9,005 [$4,792–18,615] vs $8,697 [$5,118-$18,030], p<0.041). The median cost of readmission within 1 year was $10,959 [$5,369-$23,940].
Conclusions
Previously unreported, 1 in 3 burn readmissions nationally occur at a different hospital, have unique risk factors, are costlier, and are missed by current quality metrics. For-profit hospitals have higher rates of readmissions overall.
Applicability of Research to Practice
A significant proportion of burn readmissions are missed by benchmarking and have unique risk factors, suggesting prevention programs, quality monitoring, and policy need to be changed.