Hospitalization and readmission after single-level fall: a population-based sample
Abstract Background Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predic...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-10-01
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| Series: | Injury Epidemiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40621-023-00463-4 |
| _version_ | 1797454160782688256 |
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| author | Alan Cook Rebecca Swindall Katherine Spencer Carly Wadle S. Andrew Cage Musharaf Mohiuddin Yagnesh Desai Scott Norwood |
| author_facet | Alan Cook Rebecca Swindall Katherine Spencer Carly Wadle S. Andrew Cage Musharaf Mohiuddin Yagnesh Desai Scott Norwood |
| author_sort | Alan Cook |
| collection | DOAJ |
| description | Abstract Background Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. Methods We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. Results Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. Conclusions SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation. |
| first_indexed | 2024-03-09T15:33:17Z |
| format | Article |
| id | doaj.art-8354f93908bc4b06a1e5769f5952c517 |
| institution | Directory Open Access Journal |
| issn | 2197-1714 |
| language | English |
| last_indexed | 2024-03-09T15:33:17Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Injury Epidemiology |
| spelling | doaj.art-8354f93908bc4b06a1e5769f5952c5172023-11-26T12:07:06ZengBMCInjury Epidemiology2197-17142023-10-0110111410.1186/s40621-023-00463-4Hospitalization and readmission after single-level fall: a population-based sampleAlan Cook0Rebecca Swindall1Katherine Spencer2Carly Wadle3S. Andrew Cage4Musharaf Mohiuddin5Yagnesh Desai6Scott Norwood7Trauma Services, UT Health East TexasDepartment of Epidemiology and Biostatistics, The University of Texas Health Science Center at TylerCHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus ChristiDepartment of Epidemiology and Biostatistics, The University of Texas Health Science Center at TylerDepartment of Sports Medicine, The University of Texas at TylerDepartment of Epidemiology and Biostatistics, The University of Texas Health Science Center at TylerDepartment of Emergency Medicine, UT Health East TexasTrauma Services, UT Health East TexasAbstract Background Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. Methods We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. Results Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. Conclusions SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.https://doi.org/10.1186/s40621-023-00463-4Geriatric traumaFallsReadmissionHospitalizationPalliative careHospital charges |
| spellingShingle | Alan Cook Rebecca Swindall Katherine Spencer Carly Wadle S. Andrew Cage Musharaf Mohiuddin Yagnesh Desai Scott Norwood Hospitalization and readmission after single-level fall: a population-based sample Injury Epidemiology Geriatric trauma Falls Readmission Hospitalization Palliative care Hospital charges |
| title | Hospitalization and readmission after single-level fall: a population-based sample |
| title_full | Hospitalization and readmission after single-level fall: a population-based sample |
| title_fullStr | Hospitalization and readmission after single-level fall: a population-based sample |
| title_full_unstemmed | Hospitalization and readmission after single-level fall: a population-based sample |
| title_short | Hospitalization and readmission after single-level fall: a population-based sample |
| title_sort | hospitalization and readmission after single level fall a population based sample |
| topic | Geriatric trauma Falls Readmission Hospitalization Palliative care Hospital charges |
| url | https://doi.org/10.1186/s40621-023-00463-4 |
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