Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis

Afif N Kulaylat; Dorothy V Rocourt; Anthony Y Tsai; Kathryn L Martin; Brett W Engbrecht; Mary C Santos; Robert E Cilley; Christopher S Hollenbeak; Peter W Dillon

doi:10.1016/j.jpedsurg.2017.07.021

Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis

J Pediatr Surg. 2018 Jul;53(7):1280-1287. doi: 10.1016/j.jpedsurg.2017.07.021. Epub 2017 Jul 31.

Authors

Afif N Kulaylat¹, Dorothy V Rocourt², Anthony Y Tsai², Kathryn L Martin², Brett W Engbrecht², Mary C Santos², Robert E Cilley², Christopher S Hollenbeak³, Peter W Dillon²

Affiliations

¹ Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA. Electronic address: akulaylat@pennstatehealth.psu.edu.
² Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA.
³ Division of Pediatric Surgery, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.

PMID: 28811042
DOI: 10.1016/j.jpedsurg.2017.07.021

Abstract

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.

Keywords: Pay-for-performance; Postoperative complications; Preventable; Quality; Surgical site infection.

MeSH terms

Child
Diagnosis-Related Groups
Female
Humans
Logistic Models
Male
Patient Readmission*
Pennsylvania
Postoperative Complications / epidemiology*
Quality Improvement
Reoperation
Retrospective Studies
Risk Factors
Surgical Procedures, Operative / adverse effects*
Surgical Wound Infection