Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.
Statement of Significance Literature demonstrates women living in poverty in remote areas are less likely to receive adequate health care, particularly in regard to obstetrics and gynecology. Lack of medical care during childbirth is associated with significant maternal mortality due to otherwise readily prevented or treated causes. While reproductive healthcare for women in all 'developing nations' merits consideration, this catch-all term for under-resourced regions obscures disproportionate burdens faced by a heterogeneous collection of communities facing disparate barriers to health care. Displaced women, both externally as refugees or within their nation of origin, face maternal morbidity and mortality rates at nearly twice the world average. Displaced women and those in countries deemed as undergoing a humanitarian crisis, represent the majority of all maternal deaths—both globally and among developing nations. This article considers the current state of women's health in displaced populations. Data on morbidity, mortality, and disparities in reproductive health demonstrate a violation of their human rights as defined by well-established ethical paradigms and international declarations. The onus of guaranteeing human rights to reproductive health falls well within the purview of the international medical community. Medical providers and medical organizations have a responsibility to recognize and amend these disparities and this article concludes by offering practical approaches toward this end.
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