Pediatric surgery readmissions: a root cause analysis

Hospital readmission rates are used as a metric of the quality of patient care in adults. Readmission data is lacking for pediatric surgical patients. The objective of this study is to evaluate our institution's 30-day unexpected pediatric surgical readmission data to identify potentially preventable readmissions.

An internal database of all pediatric surgical 30-day readmissions to two tertiary-referral children's hospitals in a single health system was reviewed. All pediatric general surgery admissions between January 2008 and May 2013 with hospital readmission within 30 days were included in the study. Patient demographics, diagnoses, cause of readmission, procedure performed, and length of stay were recorded. Charts were individually reviewed to evaluate causality of readmission.

There were 2217 pediatric general surgery admissions during the study period. Of these, 145 (6.5%) experienced unexpected readmission within 30 days. One-third of all readmissions occurred in infants between 0 and 364 days of age, 50% occurred in those under 2 years and wholly 80% of all readmissions occurred in those under 9 years of age. A majority of readmissions were associated with chronic comorbid conditions.

Analysis of pediatric surgical readmission data may assist hospitals in focusing quality of care and cost effectiveness strategies. Development of coordination of care strategies and discharge planning involving both pediatric surgical teams and pediatric hospitalists/specialists may reduce pediatric surgical readmission rates.