title: Unplanned Readmission to the Pediatric Cardiac Intensive Care Unit: Prevalence, Outcomes, and Risk Factors.
abstract: BACKGROUND
  Factors leading to cardiac intensive care unit (CICU) readmission and the impact on mortality have yet to be well delineated. We sought to define the prevalence and outcome for unscheduled CICU readmission. Secondary objectives were to identify indications and risk factors for unscheduled CICU readmission.
  
  
  METHODS
  Retrospective analysis of prospectively collected registry data at a tertiary care children's hospital. Pediatric and adult patients with congenital and acquired heart disease who survived to initial CICU discharge were included. Patients with unexpected return to the CICU for acute change in clinical status were defined as unscheduled readmissions.
  
  
  RESULTS
  Of the 645 discharges that met inclusion criteria, 37 resulted in unplanned readmission to the CICU. Patients requiring unscheduled readmission had higher mortality rates (16.2% vs 0.5%, P < .0001). Cardiac symptoms were the most common reason for readmission. On multivariate analysis, genetic anomaly (P = .001) and longer length of stay (LOS) during the index CICU admission (P = .01) were independently associated with readmission. For surgical patients, genetic anomaly (P = .001), single-ventricle anatomy (P = .05), and longer surgical support time (P < .001) were independently associated with readmission.
  
  
  CONCLUSIONS
  Unscheduled readmission to the CICU within the same hospitalization was uncommon but associated with a higher mortality rate. Genetic anomaly and longer initial LOS were important risk factors for the entire cohort. Single-ventricle anatomy and longer intraoperative course were risk factors for surgical readmissions.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA brunettim@email.chop.edu marissa.brunetti@verizon.net.
authors.forename: Marissa A
authors.initials: MA
authors.lastname: Brunetti
authors.affiliation: Division of Cardiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Clinical Data and Analytics, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: McCardle
authors.affiliation: Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Mott
authors.affiliation: Division of Cardiology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.affiliation: Department of Cardiac Surgery, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: congenital heart disease; congenital heart surgery; databases; intensive care; outcomes