Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative retrospective cohort study

Bindu Kalesan · Yi Zuo · Ramachandran Srini Vasan · Sandro Galea

37 citations0/0 files storedJournal of Injury and Violence Research

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Gun Ownership and Violence Research Trauma and Emergency Care Studies Injury Epidemiology and Prevention

Abstract

BACKGROUND: National conversation has justifiably been concerned with firearm-related deaths and much less attention has been paid to the consequences of surviving a firearm injury. We assessed the risk of hospital readmission, length of stay (LOS) during hospitalization, and costs within 90-days after surviving an index firearm injury and compared these data with pedestrians and occupants involved in motor vehicle crash (MVC). METHODS: Nationwide Readmission Database, a nationally representative readmission database from 2013 and 2014 was used to create a retrospective cohort study. The primary outcome was time-to-first all-cause readmission within 90-days after discharge from the index hospitalization. Secondary outcomes were LOS and hospitalization costs at index events and at 90-days. RESULTS: There were 3,334 (10.5%), 3,818 (10.6%) and 24,672 (9.4%) firearm injury, pedestrian, and occupant MVC readmissions within 90-days. The risk of 90-day readmission among firearm was 20% (HR=1.20, 95%CI=1.09-1.32) and 34% (HR=1.34, 95%CI=1.26-1.44) greater than patients admitted after pedestrian and occupant MVC. The primary causes of firearm readmission were surgical complications, intestinal disorders and open wounds. The mean total costs were lower among patients after firearm injury versus occupant MVC hospitalizations ($9,357 versus $11,032, p=0.028) but mean total LOS was greater (4.48 versus 4.38 days, p=0.003). Medicaid-insured patients had longer LOS at a total lower cost during index hospitalization after firearm injury as compared to MVC occupant injury. Increased LOS and lower costs of 90-day readmissions among firearm patients versus occupant MVC were irrespective of insurance. CONCLUSIONS: The patients surviving a firearm injury have a substantial risk of subsequent hospitalizations, higher than pedestrian or occupant MVC injuries. Medicaid is disproportionately burdened by the costs of treatment of firearm injury.

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References

2014The Epidemiology of Firearm Violence in the Twenty-First Century United States 1999The Medical Costs of Gunshot Injuries in the United States 2015Firearm-Related Hospitalization and Risk for Subsequent Violent Injury, Death, or Crime Perpetration 2013Public Health Approach to the Prevention of Gun Violence 2014The economic cost of firearm-related injuries in the United States from 2006 to 2010 2013Guns and states 2015Race and ethnicity, neighborhood poverty and pediatric firearm hospitalizations in the United States 2015Alcohol misuse, firearm violence perpetration, and public policy in the United States

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