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Context and significance of emergency department visits and readmissions after pediatric appendectomy
Timothy B Lautz1, Marleta Reynolds
1Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60614, USA. t-lautz@northwestern.edu
Insights
Pediatric appendectomy readmissions are common, but many are minor, potentially avoidable visits, not surgical complications. Improving postoperative care can reduce these emergency department visits.
Area of Science:
- Pediatric Surgery
- Clinical Outcomes Research
- Healthcare Quality Improvement
Background:
- Readmission rates after pediatric appendectomy are frequently reported without adequate context.
- Understanding these readmissions is crucial for quality improvement initiatives.
Purpose of the Study:
- To delineate the context and significance of emergency department (ED) visits and readmissions after pediatric appendectomy.
- To classify the reasons for these post-discharge encounters.
Main Methods:
- Retrospective review of patients (<18 years) who underwent appendectomy for acute appendicitis.
- Analysis of ED visits and inpatient readmissions within 90 days post-discharge.
- Classification of encounters as unrelated, surgical complications, or potentially avoidable.
Main Results:
- 18.9% of 629 patients had 141 ED visits or readmissions within 90 days.
- 42.6% of encounters were minor, potentially avoidable visits related to appendectomy.
- Potentially avoidable encounters were more frequent in Spanish-speaking patients.
Conclusions:
- Post-appendectomy ED visits and readmissions in children are common but not always due to surgical complications.
- Opportunities exist to reduce avoidable ED visits for minor postoperative concerns.
- Addressing minor issues can improve patient outcomes and reduce healthcare utilization.
Background:
The readmission rate after pediatric appendectomy is frequently reported in clinical outcomes studies and quality improvement initiatives without proper description. Our aim was to delineate the context and significance of these encounters.
Methods:
Patients (<18 years old) who underwent appendectomy for acute appendicitis at a tertiary children's hospital from January 2007 through June 2010 were reviewed. Emergency department (ED) visits and inpatient readmissions within 90 days were identified and classified as unrelated, related surgical complications, or potentially avoidable visits for minor related concerns.
Results:
Of 629 patients, 119 (18.9%) had 141 ED visits or readmissions within 90 days after discharge. Eighty-three (58.9%) encounters were limited to the ED, and 58 (41.1%) required inpatient hospitalization. Eighty-seven percent of encounters within the first 30 days after discharge, but only 26% of those occurring beyond 30 days, were related to the operation (P < .001). Overall, 45 (31.9%) ED visits or readmissions were totally unrelated to the appendectomy, 36 (25.5%) represented true surgical complications requiring inpatient hospitalization, and 60 (42.6%) were minor, potentially avoidable visits related to the appendectomy. Potentially avoidable encounters were more common in Spanish-speaking patients (P < .01).
Conclusions:
Emergency department visits and inpatient readmissions after pediatric appendectomy are frequent but not uniformly indicative of surgical complications or suboptimal care. Opportunities exist to reduce avoidable ED visits related to minor postoperative concerns.
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