The Impact of Surgical Infections on Readmission After Trauma in Geriatric Patients

Author(s):
Manuel Castillo-Angeles ; Barbara Okafor; Christine Wu; Ali Salim; Reza Askari MD

Background:

Surgical infections have been found to be more prevalent in geriatric surgical patients, leading to an increased mortality and readmission rates. However, little is known about the impact of these complications in getriatric patients after traumatic injury. The purpose of this study was to determine the impact of surgical infections on readmission rates after trauma in geriatric patients.

Hypothesis:

We hypothesize that surgical infections would represent a moderate proportion of patients being readmitted within 30 days after discharge.

Methods:

We performed a retrospective analysis of Medicare inpatient claims from 2014 to 2015. All patients 65 years or older with a diagnosis of traumatic injury were included. Surgical infections as a reason for readmission were determined by the primary ICD-9 diagnosis codes. The readmission rate was determined as the proportion of patients with an unplanned readmission within 30 days after their discharge. As a subgroup analysis, we then separated readmitted patients into those who returned to the same hospital and those who went to other hospitals. Demographic and clinical characteristics were collected. Multivariate logistic regression analysis was performed to identify the association between surgical infections and readmission.

Results:

754,313 geriatric trauma patients were included. Mean age was 82.13 (SD 0.50), 68% were female and 91% were white. 21,615 (2.87%) were readmitted within 30 days of discharge. 1,856 (8.59%) patients were reamitted due to surgical infections. Of all readmitted patients, 34% were readmitted to a hospital different than the original one. In unadjusted analysis, patients with surgical infections were more likely to be readmitted to their index admission hospital (10.46% vs. 4.96%, p <0.001). After adjusting for clinical and demographic variables, patients with surgical infections had lower rates of readmission to a different hospital (Odds Ratio [OR] 0.38, 95% Confidence Interval [CI] 0.33 – 0.43, p < 0.001).

Conclusions:

The readmission rate in geriatric trauma patients is relatively low and surgical infections do not account for a high proportion of these patients. However, surgical infections represent a reason for readmission to the index hospital, which discourages fragmentation of care. Further work is needed to keep decreasing readmissions due to surgical infections in this trauma subpopulation.