Adam B Goldin1, Kurt F Heiss2, Matt Hall3, David H Rothstein4, Peter C Minneci5, Martin L Blakely6, Marybeth Browne7, Mehul V Raval2, Samir S Shah8, Shawn J Rangel9, Charles L Snyder10, Charles D Vinocur11, Loren Berman11, Jennifer N Cooper5, Marjorie J Arca12. 1. Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. Electronic address: adam.goldin@seattlechildrens.org. 2. Emory University, Children's Healthcare of Atlanta, Atlanta, GA. 3. Children's Hospital Association, Overland Park, KS. 4. Women and Children's Hospital of Buffalo, Buffalo, NY. 5. The Research Institute at Nationwide Children's Hospital, Columbus, OH. 6. Vanderbilt University Medical Center, Nashville, TN. 7. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 8. Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 9. Boston Children's Hospital and Harvard Medical School, Boston, MA. 10. Children's Mercy Hospital, Kansas City, MO. 11. Nemours-Alfred I. DuPont Hospital for Children, Wilmington, DE. 12. Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.
Abstract
OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression. A subgroup analysis was performed comparing patients having the GT placed on the date of admission or later in the hospital course. RESULTS: Of 15 642 identified patients, 8.6% had an ED visit within 30 days of hospital discharge, and 3.9% were readmitted through the ED with a GT-related issue. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, Hispanic ethnicity, non-Hispanic black race, and the presence of ≥3 chronic conditions were independently associated with ED revisits; gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission. Timing of GT placement (scheduled vs late) was not associated with either ED revisits or hospital readmission. CONCLUSIONS: GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of nonmodifiable risk factors such as race/ethnicity and medical complexity is an initial step toward understanding this population so that interventions can be developed to decrease these potentially preventable occurrences given their importance among accountable care organizations.
OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression. A subgroup analysis was performed comparing patients having the GT placed on the date of admission or later in the hospital course. RESULTS: Of 15 642 identified patients, 8.6% had an ED visit within 30 days of hospital discharge, and 3.9% were readmitted through the ED with a GT-related issue. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, Hispanic ethnicity, non-Hispanic black race, and the presence of ≥3 chronic conditions were independently associated with ED revisits; gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission. Timing of GT placement (scheduled vs late) was not associated with either ED revisits or hospital readmission. CONCLUSIONS:GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of nonmodifiable risk factors such as race/ethnicity and medical complexity is an initial step toward understanding this population so that interventions can be developed to decrease these potentially preventable occurrences given their importance among accountable care organizations.
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Authors: Loren Berman; Carla Hronek; Mehul V Raval; Marybeth L Browne; Charles L Snyder; Kurt F Heiss; Shawn J Rangel; Adam B Goldin; David H Rothstein Journal: Pediatr Qual Saf Date: 2017-02-23