A. N. Kulaylat1, A. L. Stokes1, C. S. Hollenbeak1, B. W. Engbrecht1, D. V. Rocourt1, M. C. Santos1, R. E. Cilley1, P. W. Dillon1 1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA
Introduction: Readmission is increasingly being utilized as an important outcome and measure of hospital quality, with financial incentives and penalties tied to performance. However, less is known about the reasons for readmission in children.
Methods: This was a retrospective review of pediatric patients (n=113,102) undergoing surgery (January 1, 2012 – December 31, 2013) at US hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P). Patient characteristics and clinical data were abstracted from the NSQIP-P participant use data file and compared, stratified by the occurrence of an unplanned readmission related to the index procedure. Multivariate logistic regression was used to model factors associated with 30-day readmission. Reasons for readmission were reviewed to determine the most common causes of readmission across the represented surgical specialties.
Results: While the prevalence of unplanned readmissions was 4.2% (n=4,727), only 58.8% (n=2,781) of these readmissions, or 2.5% of children overall, were identified as readmitted within 30-days for a reason related to the index procedure. Readmission was significantly associated with patient level factors such as comorbidities, as well as the urgency of the operation, and the occurrence of postoperative complications. Overall, the most common causes for readmission were surgical site infections (SSI) (36.2%), ileus/obstruction or gastrointestinal etiologies (14.2%), and graft/implant/prosthesis-related complications (12.1%). The median time from discharge to readmission was 7 days (IQR: 3-13 days). The most common causes for readmission and time until readmission varied between surgical specialties.
Conclusion: The reasons for readmission in children undergoing surgery are varied and influenced by multiple factors, such as patient characteristics, surgical specialty, and the occurrence of postoperative complications, particularly SSI. These data provide the opportunity for risk-stratification for readmission in pediatric surgical populations and help to identify potential areas for targeted interventions to improve quality in the care of children.