Danielle B Cameron1, Dionne A Graham2, Carly E Milliren2, Stephanie Serres1, Charity C Glass1, Adam B Goldin3, Shawn J Rangel4. 1. Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA. 2. Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA. 3. Division of General and Thoracic Surgery, Seattle Children's Hospital - University of Washington School of Medicine, Seattle, WA. 4. Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA. Electronic address: shawn.rangel@childrens.harvard.edu.
Abstract
PURPOSE: The purpose of this study was to compare the relatedness of revisits to the index surgical encounter across different pediatric surgical procedures and to explore whether all-cause revisit rates are an accurate surrogate measure for related revisits in this cohort of children. METHODS: We reviewed all-cause revisits occurring within ninety days of the thirty most commonly performed pediatric surgical procedures at 44 children's hospitals between 1/1/2012 and 3/31/2015. For each condition, a team of four surgeons reviewed revisit diagnoses and reached consensus around relatedness to the index surgical encounter. Chi-squared tests were used to test for variation in all-cause and related revisits among procedures. Spearman's correlation coefficient was used to measure the association between rankings of procedures by their all-cause and related revisit rates. RESULTS: 144,535 index encounters were analyzed with an overall revisit rate of 15.0% (21,732). Significant variation was found in both the rates of all-cause revisits among procedures (ranges: 7.6-68.4%, p<0.0001), and in the relative proportions of revisits related the index surgical encounter (range: 0% to 77%, p<0.0001). Poor correlation was found between procedure rankings based on all-cause revisit rates and revisit rates related to the index admission (r=0.33, p=0.07). CONCLUSIONS: The relative proportion of revisits related to the index encounter varies significantly across pediatric surgical conditions, and poor correlation exists at the procedure-level between all-cause and related revisits rates. LEVEL OF EVIDENCE: IV.
PURPOSE: The purpose of this study was to compare the relatedness of revisits to the index surgical encounter across different pediatric surgical procedures and to explore whether all-cause revisit rates are an accurate surrogate measure for related revisits in this cohort of children. METHODS: We reviewed all-cause revisits occurring within ninety days of the thirty most commonly performed pediatric surgical procedures at 44 children's hospitals between 1/1/2012 and 3/31/2015. For each condition, a team of four surgeons reviewed revisit diagnoses and reached consensus around relatedness to the index surgical encounter. Chi-squared tests were used to test for variation in all-cause and related revisits among procedures. Spearman's correlation coefficient was used to measure the association between rankings of procedures by their all-cause and related revisit rates. RESULTS: 144,535 index encounters were analyzed with an overall revisit rate of 15.0% (21,732). Significant variation was found in both the rates of all-cause revisits among procedures (ranges: 7.6-68.4%, p<0.0001), and in the relative proportions of revisits related the index surgical encounter (range: 0% to 77%, p<0.0001). Poor correlation was found between procedure rankings based on all-cause revisit rates and revisit rates related to the index admission (r=0.33, p=0.07). CONCLUSIONS: The relative proportion of revisits related to the index encounter varies significantly across pediatric surgical conditions, and poor correlation exists at the procedure-level between all-cause and related revisits rates. LEVEL OF EVIDENCE: IV.