Musculoskeletal trauma readmissions and reoperations at a level 3 trauma unit in the UK

Crawford, Adrian; Ashwood, Neil; Stammer, Adam; Dekker, Andrew; Wilson, Paul

Item

Musculoskeletal trauma readmissions and reoperations at a level 3 trauma unit in the UK

Abstract

Abstract: Background This study explores patterns of readmissions to a trauma service in the United Kingdom (UK), where expansion of the national trauma database to include all levels of trauma unit has been underway since early in 2024 and is in the pilot phase of redevelopment. Patterns of readmissions have not been clearly defined in the UK especially for level 3 units and these can proactively be managed by institutions if recognised. Early signposting of those at risk may avoid prolonged treatment and is an opportunity to enhance patient care and recovery within the UK but also further afield. The 5535 readmissions over the last 16 years presenting to the level three trauma unit were identified from the 24, 162 presentations kept prospectively on a local trauma database. Patients were identified as having further injuries, staged operations, and complications of elective and trauma care. Descriptive statistics and univariate analysis were examined to look at factors that predict readmission and the type of cases affected with any modifications to the care pathway to improve care. Results The proportion of cases admitted once was 72.5 %, 5 % further injury in an unrelated area, 10 % had staged care and 12.5 % had complications. In those that presented with complications of care 34 % had the index operation in another hospital and 46 % were in patients who had an elective operation, mainly arthroplasty surgery. Osteoporotic refracture accounted for 15 % of the readmissions. Only 491 trauma cases (2 % of the total) had a complication of care. Conclusion Whilst improved surgical delivery and aftercare in trauma cases maybe important to prevent readmission and improve the patient's journey, it also appears equal consideration is needed in prevention of reinjury, improved definitive care rates through resource development in trauma care and enhanced elective aftercare pathways to reduce the readmissions rates into the trauma service within the UK.