title: Do all-cause revisit rates reflect the quality of pediatric surgical care provided during index encounters?
abstract: OBJECTIVE
  The purpose of this study was to compare the relatedness of revisits to the index surgical encounter across different pediatric surgical procedures and to explore whether all-cause revisit rates are an accurate surrogate measure for related revisits in this cohort of children.
  
  
  METHODS
  We reviewed all-cause revisits occurring within ninety days of the thirty most commonly performed pediatric surgical procedures at 44 children's hospitals between 1/1/2012 and 3/31/2015. For each condition, a team of four surgeons reviewed revisit diagnoses and reached consensus around relatedness to the index surgical encounter. Chi-squared tests were used to test for variation in all-cause and related revisits among procedures. Spearman's correlation coefficient was used to measure the association between rankings of procedures by their all-cause and related revisit rates.
  
  
  RESULTS
  144,535 index encounters were analyzed with an overall revisit rate of 15.0% (21,732). Significant variation was found in both the rates of all-cause revisits among procedures (ranges: 7.6-68.4%, p<0.0001), and in the relative proportions of revisits related the index surgical encounter (range: 0% to 77%, p<0.0001). Poor correlation was found between procedure rankings based on all-cause revisit rates and revisit rates related to the index admission (r=0.33, p=0.07).
  
  
  CONCLUSIONS
  The relative proportion of revisits related to the index encounter varies significantly across pediatric surgical conditions, and poor correlation exists at the procedure-level between all-cause and related revisits rates.
  
  
  METHODS
  IV.
authors.affiliation: Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cameron
authors.affiliation: Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
authors.forename: Carly E
authors.initials: CE
authors.lastname: Milliren
authors.affiliation: Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Serres
authors.affiliation: Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.
authors.forename: Charity C
authors.initials: CC
authors.lastname: Glass
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital - University of Washington School of Medicine, Seattle, WA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA. Electronic address: shawn.rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*
keywords: Comparative reporting; Pediatric surgery; Quality metric; Readmission; Revisit diagnoses