Laura H Rubinos1, Carolyn C Foster2,3, Kerri Z Machut2,3, Alexis Snyder, Eddie Simpser4, Matt Hall5, Elizabeth Casto6, Jay G Berry6. 1. Department of Pediatrics, Zuckerberg San Francisco General Hospital at the University of California San Francisco, San Francisco, CA, USA. Laura.Rubinos@ucsf.edu. 2. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 3. Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA. 4. St. Mary's Healthcare System for Children, Zucker School of Medicine at Hofstra / Northwell, Bayside, New York, USA. 5. Children's Hospital Association, Lenexa, KS, USA. 6. Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVE: To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay. STUDY DESIGN: Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated. RESULTS: The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8-2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8-2.3)], tracheostomy [OR 1.5 (95%CI 1.2-1.8)], and use of public insurance [OR 1.3 (95%CI 1.2-1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals. CONCLUSIONS: The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.
OBJECTIVE: To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay. STUDY DESIGN: Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated. RESULTS: The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8-2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8-2.3)], tracheostomy [OR 1.5 (95%CI 1.2-1.8)], and use of public insurance [OR 1.3 (95%CI 1.2-1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals. CONCLUSIONS: The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.
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