Pediatric surgical readmissions: Are they truly preventable?

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• 作者：Erin G. Brown ; ^{erin.brown@ucdmc.ucdavis.edu} ; Jamie E. Anderson ; Debra Burgess ; Richard J. Bold ; Diana L. Farmer
• 关键词：Readmission ; Preventable ; Quality improvement ; Surgery
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：161-165
• 全文大小：269 K
• 卷排序：52

文摘

Reimbursement penalties for excess hospital readmissions have begun for the pediatric population. Therefore, research determining incidence and predictors is critical.MethodsA retrospective review of University HealthSystem Consortium database (N = 258 hospitals; 2,723,621 patients) for pediatric patients (age 0–17 years) hospitalized from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and 30-day readmission rates. Hospital and patient characteristics were evaluated to identify predictors of readmission.ResultsReadmission rates at 7, 14, and 30 days were 2.1%, 3.1%, and 4.4%. For pediatric surgery patients (N = 260,042), neither index hospitalization length of stay (LOS) nor presence of a complication predicted higher readmissions. Appendectomy was the most common procedure leading to readmission. Evaluating institutional data (N = 5785), patients admitted for spine surgery, neurosurgery, transplant, or surgical oncology had higher readmission rates. Readmission diagnoses were most commonly infectious (37.2%) or for nausea/vomiting/dehydration (51.1%). Patients with chronic medical conditions comprised 55.8% of patients readmitted within 7 days. 92.0% of patients requiring multiple rehospitalizations had comorbidities.ConclusionsReadmission rates for pediatric patients are significantly lower than adults. Risk factors for adult readmissions do not predict pediatric readmissions. Readmission may be a misnomer for the pediatric surgical population, as most are related to chronic medical conditions and other nonmodifiable risk factors.Level of EvidenceLevel IV.