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Case Volume and Revisits in Children Undergoing Gastrostomy Tube Placement
Marjorie J Arca1, Shawn J Rangel, Matt Hall
1*Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI †Boston Children's Hospital and Harvard Medical School, Boston, MA ‡Children's Hospital Association, Overland Park, KS §Women and Children's Hospital of Buffalo, Buffalo, NY ||Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, TN ¶The Research Institute at Nationwide Children's Hospital, Columbus #Cincinnati Children's Hospital Medical Center, Cincinnati, OH **Emory University, Children's Healthcare of Atlanta, Atlanta, GA ††Children's Mercy Hospital, Kansas City, MO ‡‡Nemours Alfred I. duPont Hospital for Children, Wilmington, DE §§Lehigh Valley Physician Group, Allentown, PA ||||Seattle Children's Hospital, Seattle, WA.
Insights
Higher hospital gastrostomy tube (GT) placement volumes correlate with fewer emergency department (ED) revisits for pediatric patients. Increased GT insertion rates are linked to reduced ED return rates but not inpatient readmissions.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Health Services Research
Background:
- Emergency department (ED) visits and hospital readmissions are significant concerns following pediatric gastrostomy tube (GT) placement.
- Interhospital variation in these outcomes suggests potential for quality improvement.
Purpose of the Study:
- To analyze variations in pediatric gastrostomy tube (GT) revisit rates across different hospitals.
- To investigate the relationship between hospital-specific GT case volume and post-discharge ED visits or readmissions.
Main Methods:
- A retrospective cohort study utilized the Pediatric Health Information System database, including 15,642 pediatric patients (<18 years) undergoing GT placement from 2010-2012 across 38 hospitals.
- Patients were assessed for GT-related (mechanical or infectious) ED visits or inpatient readmissions at 30 and 90 days post-discharge.
- Risk-adjusted rates were calculated using generalized linear mixed-effects models to account for hospital clustering and patient attributes.
Main Results:
- A median of 468 GTs were placed per hospital over 3 years. Median ED revisit rates were 8.2% at 30 days and 14.8% at 90 days.
- Median inpatient readmission rates were 3.5% at 30 days and 5.9% at 90 days.
- Higher hospital GT insertion rates per 1000 discharges showed an inverse correlation with ED revisit rates at 30 and 90 days (P < 0.020) and decreased adjusted ED return rates (P < 0.001).
Conclusions:
- Increased hospital gastrostomy tube (GT) insertion volume is associated with a reduction in emergency department (ED) revisits for pediatric patients.
- This association was observed for both 30- and 90-day revisit rates, indicating a potential benefit of higher-volume centers for post-procedure care.
- No significant association was found between hospital GT insertion rates and inpatient readmission rates.
Objectives:
Emergency department (ED) visits and hospital readmissions are common after gastrostomy tube (GT) placement in children. We sought to characterize interhospital variation in revisit rates and explore the association between this outcome and hospital-specific GT case volume.
Patients And Methods:
We conducted a retrospective cohort study from 38 hospitals using the Pediatric Health Information System database. Patients younger than 18 years who had a GT placed in 2010 to 2012 were assessed for a GT-related (mechanical or infectious) ED visit or inpatient readmission at 30 and 90 days after discharge from GT placement. Risk-adjusted rates were calculated using generalized linear mixed-effects models accounting for hospital clustering and relevant demographic and clinical attributes, then compared across hospitals.
Results:
A total of 15,642 patients were included. A median of 468 GTs were placed in all the 38 hospitals during 3 years (range: 83-891), with a median of 11.4 GT placed per 1000 discharges (range: 2.4-16.7). Median ED visit for each hospital at 30 days after discharge was 8.2% (range: 3.7%-17.2%) and 14.8% at 90 days (range: 6.3%-26.1%). Median inpatient readmissions for each hospital at 30 days after discharge was 3.5% (range: 0.5%-10.5%) and 5.9% at 90 days (range: 1.0%-18.5%). Hospital-specific GT placement per 1000 discharges (rate of GT placement) was inversely correlated with ED visit rates at 30 (P = 0.007) and 90 days (P = 0.020). The adjusted 30- and 90-day readmission rate and the adjusted 30- and 90-day ED return rates decreased with increasing GT insertion rate (P < 0.001).
Conclusion:
Higher hospital GT insertion rates are associated with lower ED revisit rates but not inpatient readmissions.
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