Relationship between unplanned readmission and total treatment-related hospital days following management of complicated appendicitis at 31 children's hospitals.

Abstract

PURPOSE:

To examine the correlation between readmission rate and total hospital days as resource utilization and quality measures for comparative analysis.

METHODS:

Retrospective three-year audit of 8948 patients admitted with complicated appendicitis at 31 children's hospitals (6/2008-6/2011). Rates of unplanned readmission and cumulative LOS from all index and readmission encounters were analyzed for each hospital through 90 days of follow-up. The relative number and distribution of outlier hospitals identified by each measure were then compared.

RESULTS:

Significant variation was found between hospitals for readmission (aggregate rate: 13.8%, range:5.6-27.1%, chi(2) p<0.0001) and for cumulative LOS (aggregate median: 5 days, range: 4 days [IQR: 3-6] to 7 days [IQR: 4-11],Wilcoxon p<0.0001). Ten (32%) hospitals were identified as outliers by readmission rate and 11 (35%) by cumulative LOS. Although a similar number of outliers were identified for both measures, there was poor agreement in assigning high and low-utilization outlier status to individual hospitals (Weighted Kappa=0.102 [95% CI: -0.167 to 0.386]). Only 2/6 (33%) low-utilizers by readmission rate were low-utilizers by cumulative LOS, and only 2/4 (50%) low-utilizers by cumulative LOS were low-utilizers by readmission rate.

CONCLUSIONS:

There is poor correlation between unplanned readmission and total hospital days following treatment for complicated appendicitis in children. Research and reporting for this condition should incorporate both measures to provide a more comprehensive assessment of resource utilization.

• Authors: Samuel Rice-Townsend, Atul Gawande, Stuart Lipsitz, Shawn J Rangel
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 48 Issue 6 Pg. 1389-94 (Jun 2013) ISSN: 1531-5037 [Electronic] United States
• PMID: 23845635 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Adolescent
• Appendectomy
• Appendicitis (surgery)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Health Resources (statistics & numerical data)
• Hospitals, Pediatric (standards, statistics & numerical data)
• Humans
• Length of Stay (statistics & numerical data)
• Male
• Medical Audit
• Patient Readmission (statistics & numerical data)
• Quality Assurance, Health Care
• Quality Improvement
• Quality Indicators, Health Care (statistics & numerical data)
• Retrospective Studies
• United States