Advertisement

Readmissions Following Congenital Heart Surgery in Infants and Children

  • Oscar J. BenavidezEmail author
  • Wei He
  • Manuella Lahoud-Rahme
Original Article
  • 33 Downloads

Abstract

Thirty-day readmission after congenital heart surgery (CHS) is an important outcome given the vulnerability of pediatric patients. We hypothesized that readmissions after pediatric CHS are common and identifiable risk factors exist. We obtained State Inpatient Databases for Washington, New York, Florida, and California and selected CHS admissions age < 19 years. The main outcome was readmission defined as non-elective hospitalization < 31 days of discharge from index CHS admission. In multivariable analyses using generalized estimating equations, we examined associations of patient-level characteristics (age, sex, race, household income, insurance status, genetic syndromes, co-morbidities, RACHS-1 surgical risk category and complication) and admission characteristics [weekend admission, urgent/emergent admission, and high resource use (HRU)] with 30-day pediatric readmission after adjusting for case mix. Among 8585 index admissions we identified 967 readmissions (11.3%). Median length of stay for readmissions was 5 days, median total charge of $31,973, and mortality rate 1.8%. Among readmissions, 1.7% underwent another CHS of which 44% were HRU, complication rate 88% and mortality 6.25%. In multivariable analysis, age 1 month–1 year AOR 1.3 p = 0.01; Hispanic ethnicity AOR 1.2 p = 0.03; government-insurance AOR 1.3 p = 0.01; RACHS-1 3 complexity AOR 2.4 p < 0.001; RACHS-1 4 + complexity 2.0 p = 0.001; HRU AOR 1.4 p = 0.02; complications AOR 1.1 p = 0.04; and emergent index admission AOR 2.0 p < 0.001 were risk factors for readmission. Over 11% of pediatric CHS admissions result in an unplanned readmission. Hispanic ethnicity, government insurance, HRU admissions, higher case complexity, complications, and emergent index admission are risk factors for readmission.

Keywords

Readmission Congenital heart disease Quality Outcomes Pediatric cardiology 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for publication

For this type of study consent for publication is not required.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study has obtained IRB approval from and the need for informed consent was waived.

References

  1. 1.
    Benavidez OJ, Gauvreau K, Bacha E, Del Nido P, Jenkins KJ (2008) Application of a complication screening method to congenital heart surgery admissions: a preliminary report. Pediatr Cardiol 29:258–265CrossRefGoogle Scholar
  2. 2.
    Rice-Townsend S, Hall M, Barnes JN, Baxter JK, Rangel SJ (2012) Hospital readmission after management of appendicitis at freestanding children’s hospitals: contemporary trends and financial implications. J Pediatr Surg 47:1170–1176CrossRefGoogle Scholar
  3. 3.
    Berry JG, Hall DE, Kuo DZ, Cohen E, Agrawal R, Feudtner C, Hall M, Kueser J, Kaplan W, Neff J (2011) Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals. JAMA 305:682–690CrossRefGoogle Scholar
  4. 4.
    Srivastava R, Keren R (2013) Pediatric readmissions as a hospital quality measure. JAMA 309:396–398CrossRefGoogle Scholar
  5. 5.
    Islam S, Yasui Y, Kaul P, Mackie AS (2015) Hospital readmission of patients with congenital heart disease in Canada. Can J Cardiol 32:e7–e987Google Scholar
  6. 6.
    Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC (2004) Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg. 78:1972–1978 Discussion 1978 CrossRefGoogle Scholar
  7. 7.
    Jenkins KJ, Gauvreau K, Newburger JW, Kyn LB, Iezzoni LI, Mayer JE (1998) Validation of relative value scale for congenital heart operations. Ann Thorac Surg 66:860–869CrossRefGoogle Scholar
  8. 8.
    Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118CrossRefGoogle Scholar
  9. 9.
    Connor JA, Gauvreau K, Jenkins KJ (2005) Factors associated with increased resource utilization for congenital heart disease. Pediatrics 116:689–695CrossRefGoogle Scholar
  10. 10.
    Benavidez OJ, Connor JA, Gauvreau K, Jenkins KJ (2007) The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis. 2:319–326CrossRefGoogle Scholar
  11. 11.
    Jacobs JP, Benavidez OJ, Bacha EA, Walters HL, Jacobs ML (2008) The nomenclature of safety and quality of care for patients with congenital cardiac disease: a report of the Society of Thoracic Surgeons Congenital Database Taskforce Subcommittee on Patient Safety. Cardiol Young 18(Suppl 2):81–91CrossRefGoogle Scholar
  12. 12.
    Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Risk factors for death after adult congenital heart surgery in pediatric hospitals. Circ Cardiovasc Qual Outcomes 4:433–439CrossRefGoogle Scholar
  13. 13.
    Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, Feng JY, Shulman S, Chiang VW, Chiang VK, Kaplan W, Hall M, Schuster MA (2013) Pediatric readmission prevalence and variability across hospitals. JAMA 309:372–380CrossRefGoogle Scholar
  14. 14.
    Mackie AS, Ionescu-Ittu R, Pilote L, Rahme E, Marelli AJ (2008) Hospital readmissions in children with congenital heart disease: a population-based study. Am Heart J 155:577–584CrossRefGoogle Scholar
  15. 15.
    Saharan S, Legg AT, Armsby LB, Zubair MM, Reed RD, Langley SM (2014) Causes of readmission after operation for congenital heart disease. Ann Thorac Surg 98:1667–1673CrossRefGoogle Scholar
  16. 16.
    Rice-Townsend S, Hall M, Barnes JN, Lipsitz S, Rangel SJ (2013) Variation in risk-adjusted hospital readmission after treatment of appendicitis at 38 children’s hospitals: an opportunity for collaborative quality improvement. Ann Surg 257:758–765CrossRefGoogle Scholar
  17. 17.
    Kogon B, Jain A, Oster M, Woodall K, Kanter K, Kirshbom P (2012) Risk factors associated with readmission after pediatric cardiothoracic surgery. Ann Thorac Surg 94:865–873CrossRefGoogle Scholar
  18. 18.
    Hong R, Baumann BM, Boudreaux ED (2007) The emergency department for routine healthcare: race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med 32:149–158CrossRefGoogle Scholar
  19. 19.
    Hernandez AF, Curtis LH (2011) Minding the gap between efforts to reduce readmissions and disparities. JAMA 305:715–716CrossRefGoogle Scholar
  20. 20.
    Joynt KE, Orav EJ, Jha AK (2011) Thirty-day readmission rates for medicare beneficiaries by race and site of care. JAMA 305:675–681CrossRefGoogle Scholar
  21. 21.
    Kim YY, Gauvreau K, Bacha EA, Landzberg MJ, Benavidez OJ (2011) Resource use among adult congenital heart surgery admissions in pediatric hospitals: risk factors for high resource utilization and association with inpatient death. Circ Cardiovasc Qual Outcomes 4:634–639CrossRefGoogle Scholar
  22. 22.
    Benavidez OJ, Gauvreau K, Del Nido P, Bacha E, Jenkins KJ (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84:147–155CrossRefGoogle Scholar
  23. 23.
    Frei-Jones MJ, Field JJ, DeBaun MR (2009) Risk factors for hospital readmission within 30 days: a new quality measure for children with sickle cell disease. Pediatr Blood Cancer 52:481–485CrossRefGoogle Scholar
  24. 24.
    Cheney J, Barber S, Altamirano L, Medico C, Cheney M, Williams C, Jackson M, Yates P, O’Rourke P, Wainwright C (2005) A clinical pathway for bronchiolitis is effective in reducing readmission rates. J Pediatr 147:622–626CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Oscar J. Benavidez
    • 1
    Email author
  • Wei He
    • 1
  • Manuella Lahoud-Rahme
    • 1
  1. 1.Division of Pediatric-Congenital Cardiology, Department of Pediatric, MassGeneral Hospital for Children, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations