OS2-146
Seven-day and thirty-day hospital revisit rates and factors associated with revisits in children undergoing surgery at ambulatory surgical centers
1Brown S, 1Ahumada L, 1Shaw S, 2Rehman M, 1Simpao A
1Children's Hospital of Philadelphia, Philadelphia, PA, USA; 2Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
Introduction: Hospital readmissions and emergency department revisits after pediatric surgeries at outpatient ambulatory surgical facilities (surgicenters) are increasingly used as a quality care metric and may represent missed opportunities for improved care. The purpose of this retrospective cohort analysis was to determine 7- and 30-day revisit rates and factors associated with revisits in children undergoing surgery at ambulatory surgical centers.
Methods: We identified patients less than 18 years old who were cared for at four CHOP surgicenters between February 2016 and March 2017. Cardiac patients, patients with ASA Status 4 or higher, and patients who had more than 4 anesthetics during the study period were excluded. We performed manual chart review to identify two main outcome measures: the symptoms prompting revisit and primary diagnosis for the revisit.
Results: Among 7,286 patients having 7,590 surgeries at four surgicenters, 119 (1.6%) had a revisit within thirty days of surgery, while 73 (1.0%) had a revisit seven to thirty days after surgery. Most (61%) patients were ASA 2; 0.9% were ASA 3. Otolaryngology procedures and upper endoscopy were the most commonly performed procedures with the following revisit rates: tympanostomy any age (1.1%), tonsillectomy and adenoidectomy in a child <12 years (6.1%), adenoidectomy only in a child <12 years (1.1%), and upper endoscopy with biopsy any age (0.5%). The median duration between surgery and revisit was 5.9 days (IQR: 2.3, 16.5); 10% were within 1.3 days. Virtually all revisits were preceded by a phone call to a nurse triage line. Twenty-four percent presented to an outside hospital. Thirty-two percent of patients were admitted. Vomiting or dehydration (36.4%), post-surgical pain (28.5%) and fever (24.7%) were the most common causes of 7-day revisits. Revisits occurring between seven and thirty days were for fever (40.8%) or another reason (42.9%) such as seizure, constipation, or trauma. Readmissions were most commonly for post-tonsillectomy bleeding (46.8%), followed by fever (30.0%) and dehydration (29.4%).
Discussion: In a large pediatric surgical patient cohort drawn from four surgicenters, most patient revisits occurred within one week of surgery, and nearly a third of revisits resulted in admission. Revisits that occurred between seven and thirty days were less likely to be related to the surgery and anesthetic. Our findings suggest that researchers examining perioperative outcomes of pediatric surgicenter patients should focus primarily on the first 7 days after the anesthetic. Improved management of pain, nausea, and fluid status as well as providing anticipatory guidance to parents could potentially reduce revisits after surgery.
Conclusion: A majority of pediatric patients’ 7-day and 30-day revisits after ambulatory surgery are because of potentially preventable causes.
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