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Hospital Readmissions in Children with Pulmonary Hypertension: A Multi-Institutional Analysis
Jordan D Awerbach1, George B Mallory2, Shelly Kim3
1Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Insights
Pediatric pulmonary hypertension patients face high readmission rates, especially younger children and those with public insurance. Identifying these risk factors can improve care and reduce hospitalizations.
Area of Science:
- Pediatric Cardiology
- Pulmonary Medicine
- Health Services Research
Background:
- Pulmonary hypertension in children is a serious condition with significant morbidity.
- Understanding readmission patterns is crucial for optimizing pediatric healthcare resource allocation.
- Previous studies have not fully elucidated risk factors for 30-day readmissions in this specific population.
Purpose of the Study:
- To determine the rate of 30-day hospital readmissions for pediatric pulmonary hypertension.
- To identify key risk factors associated with these readmissions.
Main Methods:
- Analysis of the Pediatric Health Information System database (2005-2014).
- Inclusion of pediatric patients (≤18 years) diagnosed with pulmonary hypertension.
- Application of generalized hierarchical regression to identify predictors of 30-day readmission.
Main Results:
- A total of 13,580 patients were analyzed, with a 4-fold increase in admissions over the study period.
- The 30-day readmission rate was 26.3%, with 4.2% mortality during readmission.
- Risk factors for readmission included lower hospital volume for pulmonary hypertension and public insurance; older age and congenital heart disease were protective.
Conclusions:
- Pediatric pulmonary hypertension is associated with substantial morbidity and high intensive care unit utilization.
- Younger children and those with public insurance are at increased risk for 30-day readmission.
- Targeted interventions for high-risk groups are needed to reduce readmission rates and improve outcomes.
Objective:
To assess the rate of and risk factors for 30-day hospital readmission in children with pulmonary hypertension.
Study Design:
The Pediatric Health Information System database was analyzed for patients ≤18 years old with pulmonary hypertension (International Classification of Diseases, Ninth Revision, diagnosis codes of 416.0, 416.1, 416.8, or 416.9) admitted from 2005 through 2014. A generalized hierarchical regression model was used to determine significant ORs and 95% CIs associated with 30-day readmission.
Results:
A total of 13580 patients met inclusion criteria (median age 1.7 years [IQR 0.3-8.7], 45.3% with congenital heart disease). Admissions increased 4-fold throughout the study period. Associated hospital charges increased from $119 million in 2004 to $929 million in 2014. During initial admission, 57.4% of patients required admission to the intensive care unit, and 48.2% required mechanical ventilation. The 30-day readmission rate was 26.3%. Mortality during readmission was 4.2%. Factors increasing odds of readmission included a lower hospital volume of pulmonary hypertension admissions (1.41 [1.23-1.57], P < .001) and having public insurance (1.26 [1.16-1.38], P < .001). Decreased odds of readmission were associated with older age and the presence of congenital heart disease (0.86 [0.79-0.93], P < .001).
Conclusions:
The pediatric pulmonary hypertension population carries significant morbidity, as reflected by a high use of intensive care unit resources and a high 30-day readmission rate. Younger patients and those with public insurance represent particularly at-risk groups.
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