G. M. Taylor1, M. C. Shroyer1, A. B. Douglas1, R. T. Russell1 1University Of Alabama At Birmingham, Children’s Of Alabama,Pediatric Surgery,Birmingham, AL, USA
Introduction: Hospital readmissions account for a large proportion of health care expenditures. The patient characteristics associated with surgical readmissions in children help define preoperative patient risk factors, which may be modifiable but also may be used for preoperative family counseling. The objective of this study was to characterize readmission rates and factors associated with readmission among children following surgery.
Methods: The Pediatric National Surgical Quality Improvement Project (NSQIP) is a multicenter clinical registry from 50 participating sites collecting data to measure the quality of children's surgical care. The 2012 Pediatric NSQIP public use file (PUF) was queried for pediatric general surgical patients who had an unplanned readmission in 2012. Detailed patient and case characteristics were analyzed. Univariate and multivariate logistic regression were utilized to identify patient characteristics, clinical variables, and comorbidities predictive of unplanned readmissions.
Results: 18,643 cases were analyzed from the 2012 Pediatric NSQIP PUF file. Of these, 1111 patients (6%) experienced unplanned readmissions within 30 days of surgery. Significant preoperative variables/comorbidities associated with readmission are included in Table 1. In addition, children in the older age groups (30 days-6months, 6 months-2 years, 2-5 years, 5-12 years, and > 12 years) were more likely to be readmitted than those < 30 days old. Variables in the model that did not predict readmission included race, a preoperative diagnosis of diabetes, cerebral palsy, chronic lung disease, cystic fibrosis, major/severe cardiac risk factors, enteral or parenteral nutritional support at the time of operation, history of prematurity, and emergent/urgent operation. Infectious complications were the reason for 40% of unplanned readmissions.
Conclusions: Certain patient risk factors and comorbidities were associated with an increased risk of unplanned readmission. Though we may not be able to directly affect these risk factors, we can utilize them to counsel high risk patients and their families preoperatively about the likelihood of readmission due to these risk factors. Infectious complications were the most common reason for readmission.
