Research on Pediatric Surgery Readmission Rates

Study Overview

A team of researchers at the University of California, Davis Medical Center, has conducted a study to identify the pediatric surgeries associated with the highest rates of unplanned hospital readmissions within 30 days post-surgery. The study also examined the sociodemographic and medical risk factors contributing to these readmissions.

Data Collection and Analysis

The findings were published in JAMA Surgery and utilized data from the American College of Surgeons Pediatric National Surgery Quality Improvement Program. This program tracks surgical procedures, 30-day outcomes, and various preoperative and intraoperative risk factors linked to hospital readmissions. The analysis included data from 2012 to 2014, focusing on 183,233 children under 18 years old across 56 children’s hospitals in the United States.

Readmission Statistics

Out of the 183,233 patients included in the study, 8,838 (4.8%) were readmitted to the hospital within 30 days of their initial surgeries. Notably, 712 of these patients (8.1%) experienced multiple readmissions within the same period. The majority of these readmissions were unplanned, with nearly half not related to the initial surgeries performed.

Surgeries with High Readmission Rates

The researchers pinpointed specific pediatric surgeries with the highest 30-day unplanned readmission rates. The three procedures identified were laparoscopic ileostomy/jejunostomy, portoenterostomy, and diagnostic thoracoscopy. The first two surgeries pertain to the small bowel, while the latter is a diagnostic procedure for pulmonary disease.

Specialty Analysis

When examining readmissions by medical specialty, it was found that children undergoing neurosurgical procedures had the highest likelihood of being readmitted.

Causes of Readmissions

The study also explored the reasons behind related and unrelated readmissions. Infection at the surgical site emerged as the most prevalent cause for related readmissions. In contrast, seizures, pneumonia, and urinary tract infections were the leading causes of unrelated readmissions.

Identified Risk Factors

Several risk factors for 30-day unplanned readmissions were identified, including:
– Neurosurgical or laparoscopic procedures
– Female sex
– Asian race/ethnicity
– Higher American Society of Anesthesiologists classification
– Current cancer treatment
– Patients with cerebral palsy
– Clean-contaminated surgical cases

Conversely, neonatal patients undergoing urologic procedures were less likely to face unplanned readmissions compared to those who underwent pediatric general surgery.

Implications for Patient Care

Understanding the risk factors associated with unplanned readmissions following pediatric surgery is vital for enhancing patient care and improving overall quality. However, it is important to note that not all identified risk factors are modifiable. While the study benefits from a substantial sample size, its data is derived from only 56 children’s hospitals, which may not reflect all surgical centers nationwide.

Study Reference

Anderson, Jamie E., et al. “Association of Procedures and Patient Factors With 30-Day Readmission Rates After Pediatric Surgery.” JAMA Surgery (2017).