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Emergency room visits and readmissions after pediatric urologic surgery
Angela M Arlen1, Laura S Merriman1, Kurt F Heiss1
1Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Insights
Pediatric urologic surgery has a low rate of unplanned returns, with only 2.59% of patients needing to revisit the hospital within 30 days. These findings suggest readmission rates are not a reliable measure for quality control in pediatric urology.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Healthcare Quality Improvement
Background:
- Reducing hospital readmissions is a key goal for improving care quality and lowering healthcare costs.
- Unplanned return visits after pediatric surgery can impact patient well-being and resource utilization.
Purpose of the Study:
- To analyze the incidence and causes of all-cause unplanned return visits following pediatric urologic surgery.
- To evaluate the association between specific urologic procedures and the likelihood of return visits.
Main Methods:
- Retrospective review of 4,097 pediatric urology surgeries performed in 2012.
- Identification of patients with unplanned returns within 30 days of discharge.
- Assessment of patient demographics, insurance, surgical type, and reasons for return.
Main Results:
- A total of 106 unplanned returns (2.59%) were documented.
- Common reasons for return included pain, infection, and catheter issues.
- Circumcision, hypospadias repair, and inguinal/scrotal procedures were associated with the highest return rates.
- The overall readmission rate was 0.54%, with a reoperation rate of 0.12%.
Conclusions:
- The incidence of unplanned postoperative returns in pediatric urologic surgery is low.
- Readmission rates in children may not be a productive metric for financial savings or quality control in this population.
- Focusing on specific surgical pathways and common causes of return may offer more targeted quality improvement opportunities.
Objective:
Reducing readmissions has become a focal point to increase quality of care while reducing costs. We report all-cause unplanned return visits following urologic surgery in children at our institution.
Materials And Methods:
Children undergoing urology procedures with returns within 30 days of surgery were identified. Patient demographics, insurance status, type of surgery, and reason for return were assessed.
Results:
Four thousand and ninety-seven pediatric urology surgeries were performed at our institution during 2012, with 106 documented unplanned returns (2.59%). Mean time from discharge to return was 5.9 ± 4.9 days (range, 0.3-24.8 days). Returns were classified by chief complaint, including pain (32), infection (30), volume status (14), bleeding (11), catheter concern (8), and other (11). Circumcision, hypospadias repair, and inguinal/scrotal procedures led to the majority of return visits, accounting for 21.7%, 20.7%, and 18.9% of returns, respectively. Twenty-two returns (20.75%) resulted in hospital readmission and five (4.72%) required a secondary procedure. Overall readmission rate was 0.54%, with a reoperation rate of 0.12%.
Conclusions:
The rate of unplanned postoperative returns in the pediatric population undergoing urologic surgery is low, further strengthening the argument that readmission rates in children are not necessarily a productive focal point for financial savings or quality control.
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