Wrong hospital, wrong outcome: Impact of care fragmentation following trauma laparotomy

BACKGROUND: Care fragmentation (CF), defined as readmission to a nonindex hospital, has been identified as a potential predictor of poor outcomes after traumatic injury. Trauma laparotomy (TL) is a common procedure with perioperative risk of complications and readmission. Incidence of CF following TL, its risk factors, and its effects on outcomes are unknown. We hypothesized that CF after TL is associated with increased mortality during hospital readmission compared with continuity of care (CC). METHODS: The Nationwide Readmissions Database (2016–2022) was queried for hospitalized adult (≥18) patients with traumatic injury and open surgery of gastrointestinal or genitourinary systems during index admission, and unplanned readmission within 90 days. Demographics, comorbidities, injury severity, procedures, and disposition data were collected for patients with CF and compared with patients with CC. The primary outcome was in-hospital death during readmission. Univariate comparisons and multivariable logistic regression were performed. RESULTS: A total of 14,773 TL patients were included in the analysis. From these, 2,059 (13.9%) were readmitted within 90 days. The average age of readmitted patients was 43 years, and the majority (68.6%) were male. Of the readmissions, 441 (21.4%) experienced CF. Discharge home from the index admission was associated with lower odds of CF (OR 0.52, 95% CI: 0.32–0.84, p =0.008). On multivariable regression analysis, CF was significantly associated with in-hospital death during readmission (OR 5.09, 95% CI: 1.22–21.16, p =0.03). CONCLUSIONS: CF is common following TL and is associated with an increased risk of death on readmission, even after adjustment for baseline comorbidities and other hospital characteristics. Patients who are discharged home are less likely to experience CF. TL survivors may represent a patient population that would benefit from targeted efforts to reduce CF. LEVEL OF EVIDENCE: Therapeutic; Level III.