17 The Incidence of Adult Burn Patient Unplanned 30-Day Readmissions in the United States

Abstract

This is the first study to characterize U.S. adult burn readmissions using a nationally representative hospital inpatient sample (22 U.S. States). The objectives of the study are (1) to estimate the national 30-day unplanned hospital readmission rate for US adult burn patients, (2) to describe reasons for readmission, and (3) to identify patient and hospitalization risk factors for readmission. We queried the 2013 and 2014 Nationwide Readmission Database (NRD) for adult burn patients who were readmitted within 30 days of discharge. The data were weighted to estimate national readmission rates. Principal readmission diagnoses were sorted into burn-specific or other readmissions categories. We used multivariable logistic regression to assess the effects of patient and hospital stay traits on readmissions. An estimated 42,957 U.S. adult burn patients were discharged between January and November of 2013 and 2014. Of these patients, an estimated 3,203 had unscheduled readmissions within 30 days [All-cause readmission rate: 7.5%, 95% CI: 6.7 - 8.2]. The top three most frequent principal readmission diagnoses were burns (37.0%), septicemia (5.8%), and complications of devices/implants/grafts (4.2%). An estimated 55.4% of unplanned readmissions were for burn-specific principal readmission diagnoses. Burn-specific readmissions increased with both patient age and number of Elixhauser comorbidities. Patients whose length of stay was less than 1 day per 1% burn total body surface area (TBSA) were more likely to be readmitted [Adjusted odds ratio (AOR) = 2.10, 95% CI = 1.48 - 2.99]. The results of logistic regression models were similar for burn-specific readmissions and all-cause readmissions. Our analysis shows that about 1 in 13 U.S. adult burn patients suffered an unplanned readmission within 30 days of hospital discharge. We have described specific risk factors associated with readmission, including length of stay shorter than 1 day per 1% TBSA. Healthcare providers can use this information to identify patients at risk for unplanned readmission and perhaps modify their treatment plans accordingly.