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Unplanned Readmissions in Children with Medical Complexity in Saudi Arabia: A Large Multicenter Study
Futoon Alotaibi1,2,3, Hamad Alkhalaf1,2,3, Hissah Alshalawi1
1Department of Pediatrics, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Insights
The 30-day readmission rate for children with medical complexity in Saudi Arabia is 7.4%. Targeted interventions during and after hospitalization are crucial to reduce readmissions for these vulnerable pediatric patients.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Complex Chronic Conditions
Background:
- Children with Medical Complexity (CMC) represent a significant healthcare cost, with readmissions contributing substantially to expenditures.
- Limited data exists on the healthcare resource utilization and characteristics of CMC in Saudi Arabia.
Purpose of the Study:
- To characterize hospitalization patterns and identify factors associated with unplanned 30-day readmissions in Saudi CMC.
- To provide insights into the healthcare needs of CMC in Saudi Arabia.
Main Methods:
- Retrospective analysis of Saudi CMC (0-14 years) with unplanned 30-day readmissions across six tertiary centers (2016-2020).
- Inclusion criteria focused on CMC with multiple complex chronic conditions (CCCs) and technology assistance (TA) devices.
- Comparison of demographics, clinical data, and hospital resource utilization.
Main Results:
- A total of 680 (7.4%) of 9139 pediatric patients met the inclusion criteria for unplanned 30-day readmission.
- Genetic conditions (66.3%) and neuromuscular system involvement (33.7%) were predominant. Pneumonia was the most common diagnosis during index admission (33.1%) and readmission (32.5%).
- Readmissions occurred after two weeks in 35.1% of cases. New diagnoses or technology assistance devices were noted in 16.9% post-readmission, with a 6.6% in-hospital mortality rate.
Conclusions:
- The 7.4% unplanned 30-day readmission rate for Saudi CMC is lower than in developed countries.
- Saudi CMC with CCCs and TA devices exhibit distinct hospitalization patterns and similar readmission timing.
- Reducing readmissions requires targeted strategies during and after hospitalization for this population.
Background:
Children with medical complexity (CMC) account for a substantial proportion of healthcare spending, and one-third of their expenditures are due to readmissions. However, knowledge regarding the healthcare-resource utilization and characteristics of CMC in Saudi Arabia is limited.
Objectives:
To describe hospitalization patterns and characteristics of Saudi CMC with an unplanned 30-day readmission.
Methodology:
This retrospective study included Saudi CMC (aged 0-14 years) who had an unplanned 30-day readmission at six tertiary centers in Riyadh, Jeddah, Dammam, Alahsa, and Almadina between January 2016 and December 2020. Hospital-based inclusion criteria focused on CMC with multiple complex chronic conditions (CCCs) and technology assistance (TA) device use. CMC were compared across demographics, clinical characteristics, and hospital-resource utilization.
Results:
A total of 9139 pediatric patients had unplanned 30-day readmission during the study period, of which 680 (7.4%) met the inclusion criteria. Genetic conditions were the most predominant primary pathology (66.3%), with one-third of cases (33.7%) involving the neuromuscular system. During the index admission, pneumonia was the most common diagnosis (33.1%). Approximately 35.1% of the readmissions were after 2 weeks. Pneumonia accounted for 32.5% of the readmissions. After readmission, 16.9% of patients were diagnosed with another CCC or received a new TA device, and the in-hospital mortality rate was 6.6%.
Conclusion:
The rate of unplanned 30-day readmissions in children with medical complexity in Saudi Arabia is 7.4%, which is lower than those reported from developed countries. Saudi children with CCCs and TA devices were readmitted approximately within similar post-discharge time and showed distinct hospitalization patterns associated with specific diagnoses. To effectively reduce the risk of 30-day readmissions, targeted measures must be introduced both during the hospitalization period and after discharge.
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