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Factors associated with 30-day unplanned pediatric surgical readmission
Morgan K Richards1, David Yanez2, Adam B Goldin3
1Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; University of Washington Medical Center, 1949 NE Pacific Street, Seattle, WA 98195, USA.
Insights
Unplanned pediatric readmissions are linked to patient factors like prior emergency visits and hospital factors such as discharge timing. Addressing these can improve care quality and reduce readmission rates.
Area of Science:
- Pediatric healthcare quality
- Hospital readmission research
Background:
- Unplanned readmissions negatively impact family satisfaction and care quality.
- Identifying factors associated with pediatric readmissions is crucial for improving outcomes.
Purpose of the Study:
- To investigate patient, operative, and hospital factors associated with unplanned pediatric readmissions within 30 days of discharge.
Main Methods:
- Retrospective cohort study of 20,785 patients undergoing inpatient operations.
- Multivariable forward stepwise logistic regression analysis to identify significant predictors of readmission.
Main Results:
- 11.5% of encounters resulted in unplanned readmission (3,092 of 26,978).
- Factors associated with increased readmission risk include prior emergency department visits, American Society of Anesthesiologists (ASA) class 4 or greater, Hispanic ethnicity, and discharge on holidays/weekends.
Conclusions:
- Patient and hospital-related factors are significantly associated with unplanned pediatric readmissions.
- Discharge timing (late-day, holiday/weekend) indicates care variability and is a target for hospital quality improvement initiatives to reduce readmissions.
Background:
Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission.
Methods:
All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge.
Results:
Among 20,785 patients with an operation there were 26,978 encounters and 3,092 readmissions (11.5%). Thirteen of 33 candidate variables considered in the stepwise regression were significantly associated with readmission. Patients with an emergency department visit within 365 days of operation, American Society of Anesthesiologists class 4 or greater, Hispanic ethnicity and late-day or holiday/weekend discharges were more likely to have an unplanned readmission (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.76 to 2.19, OR = 2.00; 95% CI = 1.58 to 2.53, OR = 1.16; 95% CI = 1.04 to 1.29, OR = 2.27; 95% CI = 1.55 to 3.63. respectively).
Conclusions:
Patient and hospital factors may be associated with readmission. Day and time of discharge represent variability of care and are important targets for hospital initiatives to decrease unplanned readmission.
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