title: Case Volume and Revisits in Children Undergoing Gastrostomy Tube Placement.
abstract: Emergency department (ED) visits and hospital readmissions are common after gastrostomy tube (GT) placement in children. We sought to characterize interhospital variation in revisit rates and explore the association between this outcome and hospital-specific GT case volume.
  
  
  
  We conducted a retrospective cohort study from 38 hospitals using the Pediatric Health Information System database. Patients younger than 18 years who had a GT placed in 2010 to 2012 were assessed for a GT-related (mechanical or infectious) ED visit or inpatient readmission at 30 and 90 days after discharge from GT placement. Risk-adjusted rates were calculated using generalized linear mixed-effects models accounting for hospital clustering and relevant demographic and clinical attributes, then compared across hospitals.
  
  
  
  A total of 15,642 patients were included. A median of 468 GTs were placed in all the 38 hospitals during 3 years (range: 83-891), with a median of 11.4 GT placed per 1000 discharges (range: 2.4-16.7). Median ED visit for each hospital at 30 days after discharge was 8.2% (range: 3.7%-17.2%) and 14.8% at 90 days (range: 6.3%-26.1%). Median inpatient readmissions for each hospital at 30 days after discharge was 3.5% (range: 0.5%-10.5%) and 5.9% at 90 days (range: 1.0%-18.5%). Hospital-specific GT placement per 1000 discharges (rate of GT placement) was inversely correlated with ED visit rates at 30 (P = 0.007) and 90 days (P = 0.020). The adjusted 30- and 90-day readmission rate and the adjusted 30- and 90-day ED return rates decreased with increasing GT insertion rate (P < 0.001).
  
  
  
  Higher hospital GT insertion rates are associated with lower ED revisit rates but not inpatient readmissions.
authors.affiliation: *Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI †Boston Children's Hospital and Harvard Medical School, Boston, MA ‡Children's Hospital Association, Overland Park, KS §Women and Children's Hospital of Buffalo, Buffalo, NY ||Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, TN ¶The Research Institute at Nationwide Children's Hospital, Columbus #Cincinnati Children's Hospital Medical Center, Cincinnati, OH **Emory University, Children's Healthcare of Atlanta, Atlanta, GA ††Children's Mercy Hospital, Kansas City, MO ‡‡Nemours Alfred I. duPont Hospital for Children, Wilmington, DE §§Lehigh Valley Physician Group, Allentown, PA ||||Seattle Children's Hospital, Seattle, WA.
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Heiss
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.forename: Marybeth
authors.initials: M
authors.lastname: Browne
authors.forename: Charles D
authors.initials: CD
authors.lastname: Vinocur
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000592:standards; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States