MSS09: FRAGMENTATION OF CARE IN THE BLUNT ABDOMINAL TRAUMA PATIENT: CAPTURING OUR TRUE OUTCOMES AND IMPACT ON CARE
Matthew J Carr, MD, LCDR, USN; Jayraan Badiee, MPH; Derek Benham, MD, LT, USN; Joseph Diaz, MD, LT, USN; Richard Calvo, PhD; Vishal Bansal, MD; Carol Sise, NP, JD; Michael Sise, MD; Matthew Martin, MD; Scripps Mercy Trauma Surgery
Objective: Trauma care is associated with unplanned readmissions which may occur at facilities other than the index treatment facility. This “fragmentation” of care (FC) may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC.
Methods: We evaluated the 2016-2018 Office of Statewide Health Planning Database for all patients aged ≥15 with blunt abdominal solid organ injury with subsequent hospital readmission. Rates of fragmentation, complications, and outcomes were assessed at 1-, 3-, and 6-month intervals. Multivariable logistic regression was used to analyze deaths, complications, and FC.
Results: Of 1,580 patients meeting criteria, 752 (48%) were readmitted within 6 months to hospitals other than the index trauma facility. At index, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (6% non-FC vs. 3% FC, p=0.006). In an adjusted model, readmissions >30 days (OR 1.98, p<0.0001) and higher number of readmissions (OR 1.11, p=0.014) were associated with higher odds of fragmentation. Operative intervention at index was associated with lower odds of fragmentation (OR 0.77, p=0.039). Care fragmentation was not independently associated with demographic or insurance characteristics. Interval rates of FC and complications are shown in Figure 1.
Conclusion: Trauma patients are at significant risk for fragmented care; these readmissions and reinterventions are not captured in standard trauma registries. Despite this, trauma systems demonstrate reduced rates of FC for patients needing operative intervention for blunt solid organ injury.
Fig 1. Interval Fragmentation of Care and Complications after Blunt Solid Organ Injury
