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

J Orthop Trauma. 2020 Feb;34(2):e72-e76. doi: 10.1097/BOT.0000000000001672.

Abstract

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.