Hidden Costs of Hospitalization After Firearm Injury: National Analysis of Different Hospital Readmission

• Published in: Annals of surgery Vol. 267; no. 5; pp. 810 - 815
• Main Authors: Rattan, Rishi, Parreco, Joshua, Namias, Nicholas, Pust, Gerd D, Yeh, D Dante, Zakrison, Tanya L
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-05-2018
• Subjects: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Firearms; Hospital Costs; Hospitalization - economics; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Patient Readmission - economics; Retrospective Studies; Time Factors; United States - epidemiology; Wounds, Gunshot - economics; Wounds, Gunshot - epidemiology; Wounds, Gunshot - therapy; Young Adult; United States
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000002529

OBJECTIVE:To compare the risk factors and costs associated with readmission after firearm injury nationally, including different hospitals.
BACKGROUND:No national studies capture readmission to different hospitals after firearm injury.
METHODS:The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted after firearm injury. Logistic regression identified risk factors for 30-day same and different hospital readmission. Cost was calculated. Survey weights were used for national estimates.
RESULTS:There were 45,462 patients admitted for firearm injury during the study period. The readmission rate was 7.6%, and among those, 16.8% were readmitted to a different hospital. Admission cost was $1.45 billion and 1-year readmission cost was $131 million. Sixty-four per cent of those injured by firearms were publicly insured or uninsured. Readmission predictors includedlength of stay >7 days [odds ratio (OR) 1.43, P < 0.01], Injury Severity Score >15 (OR 1.41, P < 0.01), and requiring an operation (OR 1.40, P < 0.01). Private insurance was a predictor against readmission (OR 0.81, P < 0.01). Predictors of readmission to a different hospital were unique and includedinitial admission to a for-profit hospital (OR 1.52, P < 0.01) and median household income ≥$64,000 (OR 1.48, P < 0.01).
CONCLUSIONS:A significant proportion of the national burden of firearm readmissions is missed by not tracking different hospital readmission and its unique set of risk factors. Firearm injury-related hospitalization costs $791 million yearly, with the largest fraction paid by the public. This has implications for policy, benchmarking, quality, and resource allocation.