Readmissions Are Not What They Seem: Incidence and Classification of 30-Day Readmissions After Orthopedic Trauma Surgery.

Abstract

To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission. Retrospective chart review. One large, academic, medical center. Patients admitted to a large, academic, medical center for a traumatic fracture injury over a 9-year period. Assignment of readmission classification. 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. 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). 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. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.