title: Thirty-days readmissions in pediatric surgery: The first U.K. experience.
abstract: BACKGROUND
  The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK.
  
  
  METHODS
  Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant.
  
  
  RESULTS
  A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007).
  
  
  CONCLUSIONS
  Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK. Electronic address: cksinha@btinternet.com.
authors.forename: C K
authors.initials: CK
authors.lastname: Sinha
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: E
authors.initials: E
authors.lastname: Decker
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: D
authors.initials: D
authors.lastname: Rex
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Mukhtar
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: F
authors.initials: F
authors.lastname: Murphy
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: E
authors.initials: E
authors.lastname: Nicholls
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: B
authors.initials: B
authors.lastname: Okoye
authors.affiliation: Department of Paediatric Surgery, St George's University Hospital, London, SW17 0QT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Giuliani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom
keywords: Pediatric; Readmission within 30days; Surgery