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American Association for Hand Surgery

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Analysis of Factors Associated With Readmission Within 30 Days in the Hand Surgery Population
Paige McLean, MD1, Meera Reghunathan, MD1, Anthony M Kordahi, MD2, Madison Chakoumakos, BS1, Eric Ellorin, BS1, Rachel Segal, BS1 and Reid A. Abrams, MD3, (1)University of California, San Diego, San Diego, CA, (2)University of California San Diego, San Diego, CA, (3)Department of Orthopaedics, University of California, San Diego, San Diego, CA

Hospital readmissions in surgical patients produce a substantial cost burden to the healthcare system. There are many factors associated with increased rates of readmission including age, diagnosis of diabetes or heart disease, ASA class, discharge location, length of hospital stay, admission to ICU, insurance payer status, and strength of hospital-discharge facility linkage. Since the Affordable Care Act instituted the Hospital Readmissions Reduction Program in 2012, hospitals have been penalized for high readmission rates. Studies evaluating the costs associated with readmission have quoted penalty averages as high as $98, 490. We present a retrospective study evaluating factors associated with readmission in the inpatient hand surgery population.

Materials & Methods
A retrospective chart review was performed on patients that were admitted to the hospital for hand trauma or hand infection from January 1, 2016 to December 31, 2019. There were 360 patients total. Patients were identified using Epic Slicer Dicer to capture all patients admitted to an urban academic level 1 trauma hospital during that time for finger, hand, wrist, or forearm infection, fracture, or traumatic injury that were seen by the Hand Surgery team. For patients who met the inclusion criteria, data were collected including age, sex, diagnosis, medical comorbidities, social history, homelessness status, procedure or operative report, lab results, admission and readmission dates, antibiotic history, and insurance status. A multivariate analysis was performed to identify which factors were associated with hospital readmission within 30 days.

A multivariable regression analysis showed that a history of diabetes (p < 0.001), hypertension (p < 0.001), anemia (p < 0.001), HIV (p = 0.02), hepatitis C (p = 0.017), malnutrition (p = 0.001), psychiatric disorders (p < 0.001), and postoperative emergency department visit (p < 0.001) were significantly associated with readmission to the hospital within 30 days in the hand surgery population.

Diabetes, hypertension, anemia, HIV, hepatitis C, malnutrition, and psychiatric disorders are associated with increased rates of readmission in patients undergoing bedside or operative procedures of the hand. Further investigation is ongoing to examine social factors such as homelessness and perform subgroup analysis to determine its association with readmission in patients with hand injuries or infections.

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