Incidence and causes of 30-day readmission rate from discharge as an indicator of quality care in pediatric surgery

Abstract

Aim Evaluation and comparison 30-day readmission rate (ReAd) from discharge within three year period and to note could it be a quality-of-care indicator in pediatric surgery. Methods The case records of the patients that were readmitted within 30 days of primary surgery from January 1st2017 to December 31st2019 were identified retrospectively, for each year separately. Demographic data, diagnosis and the treatment on primary admission, length of hospital stay, and diagnosis with treatment on readmission, were collected. For each year readmissions were identified and divided into two groups (emergency and elective) based on the nature of the primary surgery. Outcomes were compared between two groups. Results A total of 5392 admissions were identified among three years (2017, n = 1821; 2018, n = 1806; 2019, n = 1765). There was 1014(55.6%) elective admissions in 2017, 953(52.8%) in 2018 and 950(53.8%) in 2019. The overall ReAd rate was 0.82%, 0.99% and 0.57% for years 2017, 2018 and 2019, respectively (p = 0.348). The most common cause for readmission was appendicitis related followed by surgical site infection in different subfields. The share of the number of readmissions during the three-year period is 3.2 times higher for emergency admissions than for elective admissions (p < 0.001). The majority(>75%) of all readmission in all three years occurred in children above age of eight. Male gender was significantly more frequently associated with readmission(74.4%)(p < 0.001). Conclusion ReAd is a reproducible and good quality-of-care indicator in pediatric surgery. An incidence of ReAd is significantly higher in emergency admissions and an appendectomy is the most common procedure associated with ReAd.