Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures

被引:11
作者
Polites, Stephanie F. [1 ]
Potter, Donald D. [1 ]
Glasgow, Amy E. [2 ]
Klinkner, Denise B. [1 ]
Moir, Christopher R. [1 ]
Ishitani, Michael B. [1 ]
Habermann, Elizabeth B. [2 ]
机构
[1] Mayo Clin, Div Pediat Surg, Rochester, MN USA
[2] Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN USA
关键词
Readmission; Pediatric surgery; Quality; HOSPITAL READMISSION; AMERICAN-COLLEGE; SURGERY; IMPROVEMENT; VALIDATION;
D O I
10.1016/j.jpedsurg.2016.11.043
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background/Purpose: Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Methods: Unplanned 30-day readmissions following general and thoracic surgical procedures in children < 18 were identified from the 2012-2014 National Surgical Quality Improvement Program-Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Results: Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p > .05). Conclusions: Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:1239 / 1244
页数:6
相关论文
共 22 条
[1]  
Agency for healthcare research and quality, 2012, CHIPR MEAS CHIPR CAT
[2]   Pediatric Readmission Prevalence and Variability Across Hospitals [J].
Berry, Jay G. ;
Toomey, Sara L. ;
Zaslavsky, Alan M. ;
Jha, Ashish K. ;
Nakamura, Mari M. ;
Klein, David J. ;
Feng, Jeremy Y. ;
Shulman, Shanna ;
Chiang, Vincent K. ;
Kaplan, William ;
Hall, Matt ;
Schuster, Mark A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2013, 309 (04) :372-380
[3]   Pediatric Surgical Technique: Laparoscopic or Open Approach? A systematic Review and Meta-Analysis [J].
Billingham, M. J. ;
Basterfield, S. J. .
EUROPEAN JOURNAL OF PEDIATRIC SURGERY, 2010, 20 (02) :73-77
[4]   Enhanced recovery protocols for major upper gastrointestinal, liver and pancreatic surgery [J].
Bond-Smith, Giles ;
Belgaumkar, Ajay P. ;
Davidson, Brian R. ;
Gurusamy, Kurinchi Selvan .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2016, (02)
[5]   American College of Surgeons National Surgical Quality Improvement Program Pediatric: A beta phase report [J].
Bruny, Jennifer L. ;
Hall, Bruce L. ;
Barnhart, Douglas C. ;
Billmire, Deborah F. ;
Dias, Mark S. ;
Dillon, Peter W. ;
Fisher, Charles ;
Heiss, Kurt F. ;
Hennrikus, William L. ;
Ko, Clifford Y. ;
Moss, Lawrence ;
Oldham, Keith T. ;
Richards, Karen E. ;
Shah, Rahul ;
Vinocur, Charles D. ;
Ziegler, Moritz M. .
JOURNAL OF PEDIATRIC SURGERY, 2013, 48 (01) :74-80
[6]  
Centers for medicare and medicaid services. Hospital quality initiative. Outcome measures, 2015, HOSP QUAL IN OUTC ME
[7]   Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients Derivation and Validation of a Prediction Model [J].
Donze, Jacques ;
Aujesky, Drahomir ;
Williams, Deborah ;
Schnipper, Jeffrey L. .
JAMA INTERNAL MEDICINE, 2013, 173 (08) :632-638
[8]   Hospital Readmission After Noncardiac Surgery The Role of Major Complications [J].
Glance, Laurent G. ;
Kellermann, Arthur L. ;
Osler, Turner M. ;
Li, Yue ;
Mukamel, Dana B. ;
Lustik, Stewart J. ;
Eaton, Michael P. ;
Dick, Andrew W. .
JAMA SURGERY, 2014, 149 (05) :439-445
[9]   The Impact of Postdischarge Telephonic Follow-Up on Hospital Readmissions [J].
Harrison, Patricia L. ;
Hara, Pamela A. ;
Pope, James E. ;
Young, Michelle C. ;
Rula, Elizabeth Y. .
POPULATION HEALTH MANAGEMENT, 2011, 14 (01) :27-32
[10]   Hospital Readmissions-Not Just a Measure of Quality [J].
Kangovi, Shreya ;
Grande, David .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 306 (16) :1796-1797