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Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis
Afif N Kulaylat1, Dorothy V Rocourt1, Anthony Y Tsai1
1Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA.
Insights
Unplanned readmissions in pediatric surgery are common, often caused by infections or gastrointestinal issues. Understanding these factors can help improve care quality and reduce readmission rates in children.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Clinical Outcomes Research
Background:
- Readmission rates are a key metric for assessing hospital quality.
- Understanding unplanned readmissions in pediatric surgery is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the rates, risk factors, and primary causes of unplanned 30-day readmissions in pediatric surgical patients.
Main Methods:
- Retrospective analysis of 130,274 pediatric patients from the Pediatric National Surgical Quality Improvement Program (NSQIP-P) database (2013-2014).
- Logistic regression modeling was used to identify factors associated with readmission.
- Reasons for readmission were categorized to find common causes.
Main Results:
- 4.7% of pediatric surgical patients were readmitted within 30 days, with 3.9% being unplanned.
- Unplanned readmissions were linked to emergent surgery status, comorbidities, and postoperative complications.
- Top readmission causes included surgical site infections (23.9%), gastrointestinal issues (16.8%), and respiratory problems (8.6%).
Conclusions:
- Pediatric surgical readmissions are multifactorial, influenced by patient specifics and complications.
- Findings support risk stratification and targeted interventions to enhance quality of care.
- Accurate interpretation of readmission rates necessitates accounting for patient case-mix.
Background:
Readmission is increasingly being utilized as an important clinical outcome and measure of hospital quality. Our aim was to delineate rates, risk factors, and reasons for unplanned readmission in pediatric surgery.
Materials And Methods:
Retrospective review of pediatric patients (n=130,274) undergoing surgery (2013-2014) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Logistic regression was used to model factors associated with unplanned 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission.
Results:
There were 6059 (n=4.7%) readmitted children within 30days of the index operation. Of these, 5041 (n=3.9%) were unplanned, with readmission rates ranging from 1.3% in plastic surgery to 5.2% in general pediatric surgery, and 10.8% in neurosurgery. Unplanned readmissions were associated with emergent status, comorbidities, and the occurrence of pre- or postdischarge postoperative complications. Overall, the most common causes for readmission were surgical site infections (23.9%), ileus/obstruction/gastrointestinal (16.8%), respiratory (8.6%), graft/implant/device-related (8.1%), neurologic (7.0%), or pain (5.8%). Median time from discharge to readmission was 8days (IQR: 3-14days). Reasons for readmission, time until readmission, and need for reoperative procedure (overall 28%, n=1414) varied between surgical specialties.
Conclusion:
The reasons for readmission in children undergoing surgery are complex, varied, and influenced by patient characteristics and postoperative complications. These data inform risk-stratification for readmission in pediatric surgical populations, and help to identify potential areas for targeted interventions to improve quality. They also highlight the importance of accounting for case-mix in the interpretation of hospital readmission rates.
Level Of Evidence:
3.
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