title: Pediatric surgical readmissions: Are they truly preventable?
abstract: OBJECTIVE
  Reimbursement penalties for excess hospital readmissions have begun for the pediatric population. Therefore, research determining incidence and predictors is critical.
  
  
  METHODS
  A retrospective review of University HealthSystem Consortium database (N=258 hospitals; 2,723,621 patients) for pediatric patients (age 0-17years) hospitalized from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and 30-day readmission rates. Hospital and patient characteristics were evaluated to identify predictors of readmission.
  
  
  RESULTS
  Readmission rates at 7, 14, and 30days were 2.1%, 3.1%, and 4.4%. For pediatric surgery patients (N=260,042), neither index hospitalization length of stay (LOS) nor presence of a complication predicted higher readmissions. Appendectomy was the most common procedure leading to readmission. Evaluating institutional data (N=5785), patients admitted for spine surgery, neurosurgery, transplant, or surgical oncology had higher readmission rates. Readmission diagnoses were most commonly infectious (37.2%) or for nausea/vomiting/dehydration (51.1%). Patients with chronic medical conditions comprised 55.8% of patients readmitted within 7days. 92.0% of patients requiring multiple rehospitalizations had comorbidities.
  
  
  CONCLUSIONS
  Readmission rates for pediatric patients are significantly lower than adults. Risk factors for adult readmissions do not predict pediatric readmissions. Readmission may be a misnomer for the pediatric surgical population, as most are related to chronic medical conditions and other nonmodifiable risk factors.
  
  
  METHODS
  Level IV.
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA. Electronic address: erin.brown@ucdmc.ucdavis.edu.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brown
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Burgess
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Farmer
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D010372:Pediatrics / Q000592:standards*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Preventable; Quality improvement; Readmission; Surgery