title: Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction.
abstract: BACKGROUND
  Bladder reconstruction in the pediatric population is challenging for many reasons, including perioperative complications and readmissions.
  
  
  OBJECTIVE
  On a national scale, determine readmission rates at 30, 60 and 90 days after bladder reconstruction in a pediatric population over a 7-year period, evaluating the influence of hospital and patient-specific variables.
  
  
  METHODS
  Using the Pediatric Health Information System database, we identified patients 0-17 years of age, from 2004-2010, undergoing bladder reconstruction using ICD-9 procedure codes. Descriptive statistics characterized demographics, prevalence of surgeries, and readmission rates. Surgery prevalence over time was examined using linear regression. Readmission rates were compared using the Chi2 test. Regression was used to evaluate the influence of variables on readmission risk.
  
  
  RESULTS
  We identified 1,985 patients for inclusion, of which 52.7% were female. Median age was 9 years. There has been no change in the prevalence of bladder reconstruction surgeries (P = 0.327). There was no change in 30-day (P = 0.272), 60-day (P = 0.788) or 90-day readmission rates (P = 0.924). Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals. Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission.
  
  
  CONCLUSIONS
  No improvement in readmission rates after pediatric bladder reconstruction was observed during the study period. Nearly all centers have a similar readmission rate despite volume adjustment.
authors.affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Pediatric Urology, Rady Children's Hospital-San Diego, University of California, San Diego, USA.
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA ; Pediatric Urology, Rady Children's Hospital-San Diego, University of California, San Diego, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Marietti
authors.affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA ; Pediatric Urology, Rady Children's Hospital-San Diego, University of California, San Diego, USA.
authors.forename: George
authors.initials: G
authors.lastname: Kaplan
authors.affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA ; Pediatric Urology, Rady Children's Hospital-San Diego, University of California, San Diego, USA.
authors.forename: George
authors.initials: G
authors.lastname: Chiang
keywords: Bladder; Complications; Database; Urology