Skip to main content
Erschienen in: Pediatric Cardiology 5/2019

11.04.2019 | Original Article

Readmissions Following Congenital Heart Surgery in Infants and Children

verfasst von: Oscar J. Benavidez, Wei He, Manuella Lahoud-Rahme

Erschienen in: Pediatric Cardiology | Ausgabe 5/2019

Einloggen, um Zugang zu erhalten

Abstract

Thirty-day readmission after congenital heart surgery (CHS) is an important outcome given the vulnerability of pediatric patients. We hypothesized that readmissions after pediatric CHS are common and identifiable risk factors exist. We obtained State Inpatient Databases for Washington, New York, Florida, and California and selected CHS admissions age < 19 years. The main outcome was readmission defined as non-elective hospitalization < 31 days of discharge from index CHS admission. In multivariable analyses using generalized estimating equations, we examined associations of patient-level characteristics (age, sex, race, household income, insurance status, genetic syndromes, co-morbidities, RACHS-1 surgical risk category and complication) and admission characteristics [weekend admission, urgent/emergent admission, and high resource use (HRU)] with 30-day pediatric readmission after adjusting for case mix. Among 8585 index admissions we identified 967 readmissions (11.3%). Median length of stay for readmissions was 5 days, median total charge of $31,973, and mortality rate 1.8%. Among readmissions, 1.7% underwent another CHS of which 44% were HRU, complication rate 88% and mortality 6.25%. In multivariable analysis, age 1 month–1 year AOR 1.3 p = 0.01; Hispanic ethnicity AOR 1.2 p = 0.03; government-insurance AOR 1.3 p = 0.01; RACHS-1 3 complexity AOR 2.4 p < 0.001; RACHS-1 4 + complexity 2.0 p = 0.001; HRU AOR 1.4 p = 0.02; complications AOR 1.1 p = 0.04; and emergent index admission AOR 2.0 p < 0.001 were risk factors for readmission. Over 11% of pediatric CHS admissions result in an unplanned readmission. Hispanic ethnicity, government insurance, HRU admissions, higher case complexity, complications, and emergent index admission are risk factors for readmission.
Literatur
1.
Zurück zum Zitat Benavidez OJ, Gauvreau K, Bacha E, Del Nido P, Jenkins KJ (2008) Application of a complication screening method to congenital heart surgery admissions: a preliminary report. Pediatr Cardiol 29:258–265CrossRefPubMed Benavidez OJ, Gauvreau K, Bacha E, Del Nido P, Jenkins KJ (2008) Application of a complication screening method to congenital heart surgery admissions: a preliminary report. Pediatr Cardiol 29:258–265CrossRefPubMed
2.
Zurück zum Zitat Rice-Townsend S, Hall M, Barnes JN, Baxter JK, Rangel SJ (2012) Hospital readmission after management of appendicitis at freestanding children’s hospitals: contemporary trends and financial implications. J Pediatr Surg 47:1170–1176CrossRefPubMed Rice-Townsend S, Hall M, Barnes JN, Baxter JK, Rangel SJ (2012) Hospital readmission after management of appendicitis at freestanding children’s hospitals: contemporary trends and financial implications. J Pediatr Surg 47:1170–1176CrossRefPubMed
3.
Zurück zum Zitat Berry JG, Hall DE, Kuo DZ, Cohen E, Agrawal R, Feudtner C, Hall M, Kueser J, Kaplan W, Neff J (2011) Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals. JAMA 305:682–690CrossRefPubMedPubMedCentral Berry JG, Hall DE, Kuo DZ, Cohen E, Agrawal R, Feudtner C, Hall M, Kueser J, Kaplan W, Neff J (2011) Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals. JAMA 305:682–690CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Srivastava R, Keren R (2013) Pediatric readmissions as a hospital quality measure. JAMA 309:396–398CrossRefPubMed Srivastava R, Keren R (2013) Pediatric readmissions as a hospital quality measure. JAMA 309:396–398CrossRefPubMed
5.
Zurück zum Zitat Islam S, Yasui Y, Kaul P, Mackie AS (2015) Hospital readmission of patients with congenital heart disease in Canada. Can J Cardiol 32:e7–e987 Islam S, Yasui Y, Kaul P, Mackie AS (2015) Hospital readmission of patients with congenital heart disease in Canada. Can J Cardiol 32:e7–e987
6.
Zurück zum Zitat Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC (2004) Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg. 78:1972–1978 Discussion 1978 CrossRefPubMed Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC (2004) Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg. 78:1972–1978 Discussion 1978 CrossRefPubMed
7.
Zurück zum Zitat Jenkins KJ, Gauvreau K, Newburger JW, Kyn LB, Iezzoni LI, Mayer JE (1998) Validation of relative value scale for congenital heart operations. Ann Thorac Surg 66:860–869CrossRefPubMed Jenkins KJ, Gauvreau K, Newburger JW, Kyn LB, Iezzoni LI, Mayer JE (1998) Validation of relative value scale for congenital heart operations. Ann Thorac Surg 66:860–869CrossRefPubMed
8.
Zurück zum Zitat Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefPubMed Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefPubMed
9.
Zurück zum Zitat Connor JA, Gauvreau K, Jenkins KJ (2005) Factors associated with increased resource utilization for congenital heart disease. Pediatrics 116:689–695CrossRefPubMed Connor JA, Gauvreau K, Jenkins KJ (2005) Factors associated with increased resource utilization for congenital heart disease. Pediatrics 116:689–695CrossRefPubMed
10.
Zurück zum Zitat Benavidez OJ, Connor JA, Gauvreau K, Jenkins KJ (2007) The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis. 2:319–326CrossRefPubMed Benavidez OJ, Connor JA, Gauvreau K, Jenkins KJ (2007) The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis. 2:319–326CrossRefPubMed
11.
Zurück zum Zitat Jacobs JP, Benavidez OJ, Bacha EA, Walters HL, Jacobs ML (2008) The nomenclature of safety and quality of care for patients with congenital cardiac disease: a report of the Society of Thoracic Surgeons Congenital Database Taskforce Subcommittee on Patient Safety. Cardiol Young 18(Suppl 2):81–91CrossRefPubMedPubMedCentral Jacobs JP, Benavidez OJ, Bacha EA, Walters HL, Jacobs ML (2008) The nomenclature of safety and quality of care for patients with congenital cardiac disease: a report of the Society of Thoracic Surgeons Congenital Database Taskforce Subcommittee on Patient Safety. Cardiol Young 18(Suppl 2):81–91CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Risk factors for death after adult congenital heart surgery in pediatric hospitals. Circ Cardiovasc Qual Outcomes 4:433–439CrossRefPubMed Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Risk factors for death after adult congenital heart surgery in pediatric hospitals. Circ Cardiovasc Qual Outcomes 4:433–439CrossRefPubMed
13.
Zurück zum Zitat Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, Feng JY, Shulman S, Chiang VW, Chiang VK, Kaplan W, Hall M, Schuster MA (2013) Pediatric readmission prevalence and variability across hospitals. JAMA 309:372–380CrossRefPubMedPubMedCentral Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, Feng JY, Shulman S, Chiang VW, Chiang VK, Kaplan W, Hall M, Schuster MA (2013) Pediatric readmission prevalence and variability across hospitals. JAMA 309:372–380CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Mackie AS, Ionescu-Ittu R, Pilote L, Rahme E, Marelli AJ (2008) Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 155:577–584CrossRefPubMed Mackie AS, Ionescu-Ittu R, Pilote L, Rahme E, Marelli AJ (2008) Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 155:577–584CrossRefPubMed
15.
Zurück zum Zitat Saharan S, Legg AT, Armsby LB, Zubair MM, Reed RD, Langley SM (2014) Causes of readmission after operation for congenital heart disease. Ann Thorac Surg 98:1667–1673CrossRefPubMed Saharan S, Legg AT, Armsby LB, Zubair MM, Reed RD, Langley SM (2014) Causes of readmission after operation for congenital heart disease. Ann Thorac Surg 98:1667–1673CrossRefPubMed
16.
Zurück zum Zitat Rice-Townsend S, Hall M, Barnes JN, Lipsitz S, Rangel SJ (2013) Variation in risk-adjusted hospital readmission after treatment of appendicitis at 38 children’s hospitals: an opportunity for collaborative quality improvement. Ann Surg 257:758–765CrossRefPubMed Rice-Townsend S, Hall M, Barnes JN, Lipsitz S, Rangel SJ (2013) Variation in risk-adjusted hospital readmission after treatment of appendicitis at 38 children’s hospitals: an opportunity for collaborative quality improvement. Ann Surg 257:758–765CrossRefPubMed
17.
Zurück zum Zitat Kogon B, Jain A, Oster M, Woodall K, Kanter K, Kirshbom P (2012) Risk factors associated with readmission after pediatric cardiothoracic surgery. Ann Thorac Surg 94:865–873CrossRefPubMed Kogon B, Jain A, Oster M, Woodall K, Kanter K, Kirshbom P (2012) Risk factors associated with readmission after pediatric cardiothoracic surgery. Ann Thorac Surg 94:865–873CrossRefPubMed
18.
Zurück zum Zitat Hong R, Baumann BM, Boudreaux ED (2007) The emergency department for routine healthcare: race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med 32:149–158CrossRefPubMed Hong R, Baumann BM, Boudreaux ED (2007) The emergency department for routine healthcare: race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med 32:149–158CrossRefPubMed
19.
Zurück zum Zitat Hernandez AF, Curtis LH (2011) Minding the gap between efforts to reduce readmissions and disparities. JAMA 305:715–716CrossRefPubMed Hernandez AF, Curtis LH (2011) Minding the gap between efforts to reduce readmissions and disparities. JAMA 305:715–716CrossRefPubMed
20.
21.
Zurück zum Zitat Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Resource use among adult congenital heart surgery admissions in pediatric hospitals: risk factors for high resource utilization and association with inpatient death. Circ Cardiovasc Qual Outcomes 4:634–639CrossRefPubMed Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Resource use among adult congenital heart surgery admissions in pediatric hospitals: risk factors for high resource utilization and association with inpatient death. Circ Cardiovasc Qual Outcomes 4:634–639CrossRefPubMed
22.
Zurück zum Zitat Benavidez OJ, Gauvreau K, Del Nido P, Bacha E, Jenkins KJ (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84:147–155CrossRefPubMed Benavidez OJ, Gauvreau K, Del Nido P, Bacha E, Jenkins KJ (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84:147–155CrossRefPubMed
23.
Zurück zum Zitat Frei-Jones MJ, Field JJ, DeBaun MR (2009) Risk factors for hospital readmission within 30 days: a new quality measure for children with sickle cell disease. Pediatr Blood Cancer 52:481–485CrossRefPubMedPubMedCentral Frei-Jones MJ, Field JJ, DeBaun MR (2009) Risk factors for hospital readmission within 30 days: a new quality measure for children with sickle cell disease. Pediatr Blood Cancer 52:481–485CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Cheney J, Barber S, Altamirano L, Medico C, Cheney M, Williams C, Jackson M, Yates P, O’Rourke P, Wainwright C (2005) A clinical pathway for bronchiolitis is effective in reducing readmission rates. J Pediatr 147:622–626CrossRefPubMed Cheney J, Barber S, Altamirano L, Medico C, Cheney M, Williams C, Jackson M, Yates P, O’Rourke P, Wainwright C (2005) A clinical pathway for bronchiolitis is effective in reducing readmission rates. J Pediatr 147:622–626CrossRefPubMed
Metadaten
Titel
Readmissions Following Congenital Heart Surgery in Infants and Children
verfasst von
Oscar J. Benavidez
Wei He
Manuella Lahoud-Rahme
Publikationsdatum
11.04.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2019
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02104-4

Weitere Artikel der Ausgabe 5/2019

Pediatric Cardiology 5/2019 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.