title: Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.
abstract: OBJECTIVE
  Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients.
  
  
  METHODS
  Unplanned 30-day readmissions following general and thoracic surgical procedures in children <18 were identified from the 2012-2014 National Surgical Quality Improvement Program- Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission.
  
  
  RESULTS
  Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05).
  
  
  CONCLUSIONS
  Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies.
  
  
  METHODS
  III.
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN. Electronic address: polites.stephanie@mayo.edu.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Potter
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Glasgow
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Denise B
authors.initials: DB
authors.lastname: Klinkner
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects
keywords: Pediatric surgery; Quality; Readmission