Key result
The overall 30-day readmission rate after orthopedic trauma surgery was 4.55%, but only 1.53% were directly due to orthopedic treatment complications (P < 0.0005).
Why the study?
The study was conducted to evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission.
What are the causes of 30-day readmissions after orthopedic trauma surgery, and how do they relate to the index admission?
Observational (n=1,955)
No
What are the causes of 30-day readmissions after orthopedic trauma surgery, and how do they relate to the index admission?
Absolute Event Rate: 4.55% vs 1.53%
p-value: p=< 0.0005
Using 30-day readmissions as a quality metric overreports preventable readmissions in orthopedic trauma, as only a third of readmissions are directly related to orthopedic complications.
Readmission metrics may overestimate preventable orthopedic complications after trauma; leaves open their validity as quality indicators.
OBJECTIVES: To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission. DESIGN: Retrospective chart review. SETTING: One large, academic, medical center. PARTICIPANTS: Patients admitted to a large, academic, medical center for a traumatic fracture injury over a 9-year period. INTERVENTION: Assignment of readmission classification. MAIN OUTCOME MEASURES: Readmissions within 30 days of discharge were identified and classified into orthopedic complications, medical complications, and noncomplications. A χ test was performed to assess any difference in the proportion of readmissions between the hospital-reported readmission rate and the orthopedic complication readmission rate. RESULTS: One thousand nine hundred fifty-five patients who were admitted between 2011 and 2018 for an acute orthopedic trauma fracture injury were identified. Eighty-nine patients were readmitted within 30 days of discharge with an overall readmission rate of 4.55%. Within the 30-day readmission cohort, 30 (33.7%) were the direct result of orthopedic treatment complications, 36 (40.4%) were unrelated medical conditions, and 23 (25.8%) were noncomplications. Thus, the readmission rate directly due to orthopedic treatment complications was 1.53%. A χ test of homogeneity revealed a statistically significant difference between the hospital-reported readmission rate and the orthopedic-treatment complication readmission rate (P < 0.0005). CONCLUSION: The use of 30-day readmissions as a measure of hospital quality of care overreports the number of preventable readmissions and penalizes surgeons and hospitals for caring for patients with less optimal health. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Kelly et al. (2019) conducted an observational in Acute orthopedic trauma fracture injury (n=1,955). Orthopedic trauma surgery was evaluated on Difference between hospital-reported readmission rate and orthopedic-treatment complication readmission rate (p=< 0.0005). The overall 30-day readmission rate after orthopedic trauma surgery was 4.55%, but only 1.53% were directly due to orthopedic treatment complications (P < 0.0005).
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