Most Kids' Readmissions Stem From Initial Surgeries

Major Finding: More than half (59%) of 30-day readmissions for pediatric general surgery patients were related to their initial surgeries or procedures.

Data Source: The data come from 12,438 surgical admissions at a single center between January 2007 and December 2010.

Disclosures: Dr. Marshall had no financial conflicts to disclose.



CHICAGO – A majority of unplanned 30-day readmissions of general surgery patients to a pediatric hospital resulted from the initial surgery or procedure for which the child was hospitalized, according to data on more than 300 patients. The findings were presented at the annual clinical congress of the American College of Surgeons.

Hospital readmission within 30 days has become an important quality measure, but data on the frequency and epidemiology of pediatric surgery readmissions are limited, said Dr. Andre Marshall of Vanderbilt University, Nashville, Tenn.

"In order to decrease readmissions, pediatric surgeons must know where to focus efforts," he said.

To determine the proportion of readmissions associated with each surgical service, Dr. Marshall and colleagues reviewed data from 12,438 surgical admissions at a single center between January 2007 and December 2010. Data were taken from the Pediatric Health Information System database and electronic medical records.

A 30-day readmission was defined as any readmission within 30 days of an index hospitalization. Surgical services included general surgery, thoracic surgery, neurosurgery, cardiac surgery, orthopedics, otolaryngology, urologic surgery, ophthalmology, plastic surgery, and kidney and liver transplants.

In all, 1,178 patients were readmitted during the study period, for a readmission rate of 10%. Of these, 318 (27%) were general surgery readmissions. The next highest readmission rates by specialty were neurosurgery (26%), cardiac surgery (18%), and orthopedics (10%). The average age of the readmitted patients was 3 years, and 58% were male.

Of the 318 general surgery readmissions, 295 were unplanned, Dr. Marshall said. Of these, 174 (59%) were related to the index surgery or procedure, and 121 (41%) were related to a new illness, new trauma, or other reason not related to the initial procedure.

Among general surgery patients, infection complications were the most common reason for 30-day readmission (38%), followed by gastrointestinal issues (28%), respiratory complications (9%), planned readmissions (7%), postoperative pain (5%), and other (13%).

The most common preoperative diagnoses associated with 30-day readmission were acute appendicitis (18%), congenital malformations (17%), and gastroesophageal reflux disease (14%).

"Improving processes to anticipate which patients and diagnoses are at the greatest risk of 30-day readmission will potentially allow for early interventions by providers," Dr. Marshall said. Early intervention will allow clinicians to implement strategies to help reduce overall readmission rates and improve the quality of patient care, he added.

Dr. Marshall had no financial conflicts to disclose.

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