23 - COMPARING SEVERELY INJURED TRAUMA PATIENTS ADMITTED TO INVESTOR-OWNED VERSUS PUBLIC AND NOT-FOR-PROFIT HOSPITALS REVEALS OPPORTUNITIES FOR IMPROVEMENT IN US

Objectives: Severely injured, non-elderly trauma patients represent the largest portion of potentially preventable years of productive life loss in the United States. The purpose of this study was to compare outcomes in these patients admitted to investor-owned versus public and not-for-profit hospitals across the US.

Methods: The Nationwide Readmissions Database for 2018 was queried for all trauma patients with an Injury Severity Score (ISS) of greater than 15 and an age of 18-65 years. The primary outcome was mortality, the secondary outcomes were prolonged length of stay (LOS) greater than 30-days, readmission within 30-days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were identified and compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome with all variables significant on univariable analysis.

Results: There were 157,945 patients meeting inclusion criteria with 11.0% (n=17,346) admitted to investor-owned hospitals. The overall mortality rate was 4.7% (n=7,360) while the rate for investor-owned hospitals was 4.8% (n=836, p=0.29). The overall rate of prolonged LOS was 5.8% (n=9,182) and the rate for investor-owned hospitals was 6.0% (n=1,036, p=0.34). The overall readmission rate was 9.2% (n=13,895) with the rate in investor-owned hospitals at 10.5% (n=1,739, p< 0.001). From the readmitted patients, 28.7% (n=3,992) were readmitted to a different hospital while investor-owned hospitals had a different-hospital readmission rate of 35.7% (n=622, p< 0.001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] p< 0.001) and readmission to a different hospital (OR 1.3 [1.2-1.5] p< 0.001).

Conclusion: Severely injured trauma patients admitted to investor-owned hospitals have similar rates of mortality and prolonged length of stay compared to public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to reduce readmissions after trauma must consider differences based on hospital ownership.