Trends and Outcomes in Patients with Rib Fractures, 2016–2020: A Retrospective Cohort Study from the Nationwide Readmissions Database

Jarva Chow,1,* Elizabeth R Hall,1,* Hua She,2,* Sajid Shahul1,* 1Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA; 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA*These authors contributed equally to this workCorrespondence: Jarva Chow, University of Chicago, Department of Anesthesia & Critical Care, 5841 S. Maryland Ave. MC4028, Chicago, IL, 60637, USA, Email [email protected]: Readmissions are associated with worse patient outcomes, higher length of stay, and increased costs. Reducing unnecessary readmissions represents a significant opportunity for improving patient outcomes and healthcare delivery.Patients and methods: This was a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD), part of the United States Healthcare Cost and Utilization Project (HCUP). The NRD was queried to identify all adult (> 18 years old) trauma patients with an admission diagnosis of rib fractures. Demographic and hospital data, comorbidities, as well as morbidity and mortality outcomes were collected.Results: The 2016– 2020 NRD identified 553,810 patients admitted with a diagnosis of rib fractures, with 65,244 of those patients readmitted within 30 days of discharge. Patients with rib fractures who were readmitted within 30 days were associated with 9-fold higher mortality over six months than if they were not readmitted. Patients with rib fractures were more likely to be readmitted from small or medium-sized hospitals (p< 0.001), had underlying depression (OR 1.42, 95% CI [1.34– 1.51]), drug abuse (OR 1.23, 95% CI [1.13,1.35]), chronic pulmonary disease (OR 1.49, 95% CI [1.41,1.57]), and obesity (OR1.22, 95% CI [1.13– 1.31]). There was an association with higher readmission rates in patients with a single rib fracture compared with multiple rib fractures.Conclusion: Patients readmitted within 30 days of discharge with rib fractures are associated with higher six-month mortality. Rib fractures are a common injury in trauma patients. Reducing unnecessary readmissions in this patient population may improve patient outcomes, satisfaction, and decrease healthcare costs.Keywords: trauma, readmissions, risk factors, retrospective review, rib fractures