Abstract

Background: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. Materials and methods: Retrospective review of pediatric patients (n = 130,274) undergoing surgery (2013–2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission. Results: There were 6059 (n = 4.7%) readmitted children within 30 days of the index operation. Of these, 5041 (n = 3.9%) were unplanned, with readmission rates ranging from 1.3% in plastic surgery to 5.2% in general pediatric surgery, and 10.8% in neurosurgery. Unplanned readmissions were associated with emergent status, comorbidities, and the occurrence of pre- or postdischarge postoperative complications. Overall, the most common causes for readmission were surgical site infections (23.9%), ileus/obstruction/gastrointestinal (16.8%), respiratory (8.6%), graft/implant/device-related (8.1%), neurologic (7.0%), or pain (5.8%). Median time from discharge to readmission was 8 days (IQR: 3–14 days). Reasons for readmission, time until readmission, and need for reoperative procedure (overall 28%, n = 1414) varied between surgical specialties. Conclusion: The reasons for readmission in children undergoing surgery are complex, varied, and influenced by patient characteristics and postoperative complications. These data inform risk-stratification for readmission in pediatric surgical populations, and help to identify potential areas for targeted interventions to improve quality. They also highlight the importance of accounting for case-mix in the interpretation of hospital readmission rates. Level of evidence: 3.

Original languageEnglish (US)
Pages (from-to)1280-1287
Number of pages8
JournalJournal of Pediatric Surgery
Volume53
Issue number7
DOIs
StatePublished - Jul 1 2018

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Pediatrics
Surgical Specialties
Surgical Wound Infection
Patient Readmission
Ileus
Diagnosis-Related Groups
Neurosurgery
Plastic Surgery
Quality Improvement
Nervous System
Comorbidity
Logistic Models
Outcome Assessment (Health Care)
Transplants
Pain
Equipment and Supplies
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{def9b529130645bc88d053d28f71de22,
title = "Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis",
abstract = "Background: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. Materials and methods: Retrospective review of pediatric patients (n = 130,274) undergoing surgery (2013–2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission. Results: There were 6059 (n = 4.7{\%}) readmitted children within 30 days of the index operation. Of these, 5041 (n = 3.9{\%}) were unplanned, with readmission rates ranging from 1.3{\%} in plastic surgery to 5.2{\%} in general pediatric surgery, and 10.8{\%} in neurosurgery. Unplanned readmissions were associated with emergent status, comorbidities, and the occurrence of pre- or postdischarge postoperative complications. Overall, the most common causes for readmission were surgical site infections (23.9{\%}), ileus/obstruction/gastrointestinal (16.8{\%}), respiratory (8.6{\%}), graft/implant/device-related (8.1{\%}), neurologic (7.0{\%}), or pain (5.8{\%}). Median time from discharge to readmission was 8 days (IQR: 3–14 days). Reasons for readmission, time until readmission, and need for reoperative procedure (overall 28{\%}, n = 1414) varied between surgical specialties. Conclusion: The reasons for readmission in children undergoing surgery are complex, varied, and influenced by patient characteristics and postoperative complications. These data inform risk-stratification for readmission in pediatric surgical populations, and help to identify potential areas for targeted interventions to improve quality. They also highlight the importance of accounting for case-mix in the interpretation of hospital readmission rates. Level of evidence: 3.",
author = "Kulaylat, {Afif N.} and Dorothy Rocourt and Anthony Tsai and Kathryn Martin and Brett Engbrecht and Santos, {Mary Catherine} and Robert Cilley and Hollenbeak, {Christopher S.} and Peter Dillon",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.jpedsurg.2017.07.021",
language = "English (US)",
volume = "53",
pages = "1280--1287",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Understanding readmissions in children undergoing surgery

T2 - A pediatric NSQIP analysis

AU - Kulaylat, Afif N.

AU - Rocourt, Dorothy

AU - Tsai, Anthony

AU - Martin, Kathryn

AU - Engbrecht, Brett

AU - Santos, Mary Catherine

AU - Cilley, Robert

AU - Hollenbeak, Christopher S.

AU - Dillon, Peter

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. Materials and methods: Retrospective review of pediatric patients (n = 130,274) undergoing surgery (2013–2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission. Results: There were 6059 (n = 4.7%) readmitted children within 30 days of the index operation. Of these, 5041 (n = 3.9%) were unplanned, with readmission rates ranging from 1.3% in plastic surgery to 5.2% in general pediatric surgery, and 10.8% in neurosurgery. Unplanned readmissions were associated with emergent status, comorbidities, and the occurrence of pre- or postdischarge postoperative complications. Overall, the most common causes for readmission were surgical site infections (23.9%), ileus/obstruction/gastrointestinal (16.8%), respiratory (8.6%), graft/implant/device-related (8.1%), neurologic (7.0%), or pain (5.8%). Median time from discharge to readmission was 8 days (IQR: 3–14 days). Reasons for readmission, time until readmission, and need for reoperative procedure (overall 28%, n = 1414) varied between surgical specialties. Conclusion: The reasons for readmission in children undergoing surgery are complex, varied, and influenced by patient characteristics and postoperative complications. These data inform risk-stratification for readmission in pediatric surgical populations, and help to identify potential areas for targeted interventions to improve quality. They also highlight the importance of accounting for case-mix in the interpretation of hospital readmission rates. Level of evidence: 3.

AB - Background: Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery. Materials and methods: Retrospective review of pediatric patients (n = 130,274) undergoing surgery (2013–2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission. Results: There were 6059 (n = 4.7%) readmitted children within 30 days of the index operation. Of these, 5041 (n = 3.9%) were unplanned, with readmission rates ranging from 1.3% in plastic surgery to 5.2% in general pediatric surgery, and 10.8% in neurosurgery. Unplanned readmissions were associated with emergent status, comorbidities, and the occurrence of pre- or postdischarge postoperative complications. Overall, the most common causes for readmission were surgical site infections (23.9%), ileus/obstruction/gastrointestinal (16.8%), respiratory (8.6%), graft/implant/device-related (8.1%), neurologic (7.0%), or pain (5.8%). Median time from discharge to readmission was 8 days (IQR: 3–14 days). Reasons for readmission, time until readmission, and need for reoperative procedure (overall 28%, n = 1414) varied between surgical specialties. Conclusion: The reasons for readmission in children undergoing surgery are complex, varied, and influenced by patient characteristics and postoperative complications. These data inform risk-stratification for readmission in pediatric surgical populations, and help to identify potential areas for targeted interventions to improve quality. They also highlight the importance of accounting for case-mix in the interpretation of hospital readmission rates. Level of evidence: 3.

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