Do all-cause revisit rates reflect the quality of pediatric surgical care provided during index encounters?

J Pediatr Surg. 2017 Jun;52(6):1050-1055. doi: 10.1016/j.jpedsurg.2017.03.034. Epub 2017 Mar 18.

Abstract

Purpose: 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.

Level of evidence: IV.

Keywords: Comparative reporting; Pediatric surgery; Quality metric; Readmission; Revisit diagnoses.

Publication types

  • Comparative Study

MeSH terms

  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hospitals, Pediatric / standards*
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Male
  • Patient Readmission / statistics & numerical data*
  • Perioperative Care / standards*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Quality Indicators, Health Care / statistics & numerical data*
  • Retrospective Studies
  • Surgical Procedures, Operative / standards*