title: Emergency Department Visits and Readmissions among Children after Gastrostomy Tube Placement.
abstract: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals.
  
  
  
  This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression. A subgroup analysis was performed comparing patients having the GT placed on the date of admission or later in the hospital course.
  
  
  
  Of 15 642 identified patients, 8.6% had an ED visit within 30 days of hospital discharge, and 3.9% were readmitted through the ED with a GT-related issue. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, Hispanic ethnicity, non-Hispanic black race, and the presence of ≥3 chronic conditions were independently associated with ED revisits; gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission. Timing of GT placement (scheduled vs late) was not associated with either ED revisits or hospital readmission.
  
  
  
  GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of nonmodifiable risk factors such as race/ethnicity and medical complexity is an initial step toward understanding this population so that interventions can be developed to decrease these potentially preventable occurrences given their importance among accountable care organizations.
authors.affiliation: Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. Electronic address: adam.goldin@seattlechildrens.org.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Heiss
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Women and Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
authors.affiliation: The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Marybeth
authors.initials: M
authors.lastname: Browne
authors.affiliation: Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Children's Mercy Hospital, Kansas City, MO.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.affiliation: Nemours-Alfred I. DuPont Hospital for Children, Wilmington, DE.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Vinocur
authors.affiliation: Nemours-Alfred I. DuPont Hospital for Children, Wilmington, DE.
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.affiliation: The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Pediatric Health Information System; complex chronic condition; emergency department; gastroesophageal reflux disease; gastrostomy tube