title: Relationship between unplanned readmission and total treatment-related hospital days following management of complicated appendicitis at 31 children's hospitals.
abstract: OBJECTIVE
  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.affiliation: Department of Pediatric Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rice-Townsend
authors.forename: Atul
authors.initials: A
authors.lastname: Gawande
authors.forename: Stuart
authors.initials: S
authors.lastname: Lipsitz
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: Appendicitis; Cost-effectiveness; Quality improvement; Readmission; Resource Utilization; Surgery