Hospitalization and readmission after single-level fall: a population-based sample

Alan Cook; Rebecca Swindall; Katherine Spencer; Carly Wadle; S Andrew Cage; Musharaf Mohiuddin; Yagnesh Desai; Scott Norwood

doi:10.1186/s40621-023-00463-4

Hospitalization and readmission after single-level fall: a population-based sample

Inj Epidemiol. 2023 Oct 19;10(1):49. doi: 10.1186/s40621-023-00463-4.

Authors

Alan Cook¹, Rebecca Swindall², Katherine Spencer³, Carly Wadle², S Andrew Cage⁴, Musharaf Mohiuddin⁵, Yagnesh Desai⁶, Scott Norwood¹

Affiliations

¹ Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA.
² Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA.
³ CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus Christi, 600 Elizabeth Street, 9B, Corpus Christi, TX, 78404, USA.
⁴ Department of Sports Medicine, The University of Texas at Tyler, 3900 University Blvd., Tyler, TX, 75799, USA.
⁵ Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA. musharaf.mohiuddin@uthct.edu.
⁶ Department of Emergency Medicine, UT Health East Texas, 1000 S. Beckham Ave., Tyler, TX, 75701, USA.

Abstract

Background: Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older.

Methods: We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge.

Results: Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually.

Conclusions: SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.

Keywords: Falls; Geriatric trauma; Hospital charges; Hospitalization; Palliative care; Readmission.