Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications.
BACKGROUND
The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis.


METHODS
We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters.


RESULTS
The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P < .0001). The median hospital cost per case attributable to readmission was $3401 (reflecting a 44% relative increase in cumulative treatment-related cost), and this varied significantly by disease severity and management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001).


CONCLUSIONS
In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies.
Department of Pediatric Surgery, Children's Hospital Boston Harvard Medical School, Boston, MA 02115, USA.
Samuel
S
Rice-Townsend
Matthew
M
Hall
Jeff N
JN
Barnes
Jessica K
JK
Baxter
Shawn J
SJ
Rangel
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data; D001064:Appendicitis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D001900:Boston; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016208:Databases, Factual; D019468:Disease Management; D004322:Drainage / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000639:trends*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents