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Thirty-days readmissions in pediatric surgery: The first U.K. experience
1Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
Insights
Pediatric surgical readmissions within 30 days are uncommon, with appendicectomy being the most frequent cause. Emergency operations have a higher readmission rate than elective ones, highlighting the need for better discharge planning.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Quality Indicators
Background:
- Readmissions within 30 days of operation (ReAd) are a critical metric in surgical care.
- Limited data exists on pediatric surgical readmissions in the UK.
Purpose of the Study:
- To investigate the incidence and causes of 30-day readmissions in a UK tertiary pediatric surgical practice.
- To compare readmission rates between elective and emergency pediatric surgical cases.
Main Methods:
- Retrospective analysis of Hospital Episode Statistics for pediatric surgical procedures.
- Data collection included demographics, comorbidities, diagnoses, treatments, and length of stay.
- Exclusion of neonates; classification of readmissions into elective and emergency cohorts.
Main Results:
- Overall 30-day readmission rate was 2% (n=2378 procedures).
- Appendicectomy was the most common primary procedure leading to readmission (26%).
- Postoperative infection was the leading cause of readmission (30%); emergency cases had significantly higher readmissions (3.5% vs 1.5%, P=0.007).
Conclusions:
- Pediatric surgical readmissions are infrequent but warrant attention, particularly for appendicectomy.
- Elective procedures demonstrate lower readmission rates than emergency procedures.
- Efficient discharge planning may reduce readmissions; further validation of readmission rates as a pediatric quality indicator is needed.
Introduction:
The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK.
Methods:
Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant.
Results:
A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007).
Conclusion:
Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.
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