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Pediatric surgical readmissions: Are they truly preventable?
Erin G Brown1, Jamie E Anderson1, Debra Burgess1
1University of California, Davis Health System, Sacramento, CA, USA.
Insights
Pediatric hospital readmission rates are lower than adults, with chronic conditions being a major factor. Adult predictors do not apply to children, suggesting readmission may be mislabeled for this group.
Area of Science:
- Pediatric hospital readmissions
- Healthcare quality metrics
- Patient outcomes
Background:
- Reimbursement penalties for excess hospital readmissions are now applicable to pediatric populations.
- Understanding pediatric readmission incidence and predictors is crucial for healthcare providers and policymakers.
Purpose of the Study:
- To determine the incidence and predictors of pediatric hospital readmissions.
- To evaluate if adult readmission risk factors are applicable to pediatric patients.
Main Methods:
- Retrospective review of the University HealthSystem Consortium database.
- Inclusion of 2,723,621 pediatric patients (0-17 years) hospitalized between September 2011 and March 2015.
- Analysis of 7-, 14-, and 30-day readmission rates and associated patient/hospital characteristics.
Main Results:
- Overall 7-, 14-, and 30-day readmission rates were 2.1%, 3.1%, and 4.4%, respectively.
- In pediatric surgery, length of stay and complications did not predict readmissions; appendectomy was the most common procedure leading to readmission.
- Patients with chronic medical conditions accounted for 55.8% of 7-day readmissions and 92.0% of multiple rehospitalizations.
Conclusions:
- Pediatric readmission rates are substantially lower than adult rates.
- Risk factors identified for adult readmissions do not predict pediatric readmissions.
- Pediatric readmissions, particularly in surgical populations, are often linked to chronic conditions and nonmodifiable risk factors, suggesting a need for revised terminology or understanding.
Background/Purpose:
Reimbursement penalties for excess hospital readmissions have begun for the pediatric population. Therefore, research determining incidence and predictors is critical.
Methods:
A retrospective review of University HealthSystem Consortium database (N=258 hospitals; 2,723,621 patients) for pediatric patients (age 0-17years) hospitalized from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and 30-day readmission rates. Hospital and patient characteristics were evaluated to identify predictors of readmission.
Results:
Readmission rates at 7, 14, and 30days were 2.1%, 3.1%, and 4.4%. For pediatric surgery patients (N=260,042), neither index hospitalization length of stay (LOS) nor presence of a complication predicted higher readmissions. Appendectomy was the most common procedure leading to readmission. Evaluating institutional data (N=5785), patients admitted for spine surgery, neurosurgery, transplant, or surgical oncology had higher readmission rates. Readmission diagnoses were most commonly infectious (37.2%) or for nausea/vomiting/dehydration (51.1%). Patients with chronic medical conditions comprised 55.8% of patients readmitted within 7days. 92.0% of patients requiring multiple rehospitalizations had comorbidities.
Conclusions:
Readmission rates for pediatric patients are significantly lower than adults. Risk factors for adult readmissions do not predict pediatric readmissions. Readmission may be a misnomer for the pediatric surgical population, as most are related to chronic medical conditions and other nonmodifiable risk factors.
Level Of Evidence:
Level IV.
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