Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel, Tamar; Laskin, Benjamin L.; Furth, Susan L.

doi:10.2215/cjn.05410513

Cited by 15 publications

(8 citation statements)

References 25 publications

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“…The overall readmission rate in PD patients within our study is similar to readmission rates reported by others: 25% in a pediatric U.S. PD population, and 19.8% in readmission due to infection-related hospitalizations in a Canadian population (7,9). Of note, our estimate is nearly twice that of a recent study focusing on the readmission burden in the U.S. PD population (15%) (15).…”

Section: Discussionsupporting

confidence: 89%

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Sahlie

Jaar

Paez³

et al. 2019

Perit Dial Int

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Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, and race did not differ by readmission status. After adjustment for patient and index admission characteristics, longer length of stay (≥ 4 vs < 4 days, OR = 1.48, 95% confidence interval [CI] 1.35 – 1.62), peripheral arterial disease (OR = 1.31, 95% CI 1.16 – 1.57), congestive heart failure (OR = 1.25, 95% CI 1.13 – 1.39), and ischemic heart disease (OR = 1.12, 95% CI 1.01 – 1.24) were associated with higher likelihood of readmission; index admission due to peritonitis vs other causes was associated with lower likelihood of readmission (OR = 0.80, 95% CI 0.70 – 0.92). Conclusions Our results suggest that, particularly in the absence of a PD-related cause of hospitalization such as peritonitis, PD patients may be at high risk for readmission and may benefit from closer post-discharge monitoring.

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Section: Discussionsupporting

confidence: 89%

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Sahlie

Jaar

Paez³

et al. 2019

Perit Dial Int

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“…We identified that length of index hospital stay was an independent risk factor of 30-day unexpected rehospitalization. Patients with longer hospital stay always presented with more severe or complicated disease condition during index admission [ 26 ]. Such complex condition not only prolonged their index hospital care, but also made them more vulnerable to an unexpected rehospitalization.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients

Huang

et al. 2021

BMC Nephrol

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Background Rehospitalization is a major problem for end stage renal disease (ESRD) populations. However, researches on 30-day unexpected rehospitalzation of incident peritoneal dialysis (PD) patients were limited. This study aimed to investigate the prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident PD patients. Methods This was a retrospective cohort study. Patients who accepted PD catheter implantation in our centre from Jan 1, 2006 to Dec 31, 2013 and regular follow-up were included. The demographic characteristics, laboratory parameters, and rehospitalization data were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular disease (CVD) mortality and technical failure. Results Totally 1632 patients (46.9 ± 15.3 years old, 60.1% male, 25.6% with diabetes) were included. Among them, 149 (9.1%) had a 30-day unexpected rehospitalization after discharge. PD-related peritonitis (n = 48, 32.2%), catheter malfunction (n = 30, 20.1%) and severe fluid overload (n = 19, 12.8%) were the top three causes for the rehospitalization. Multivariate logistic regression analysis showed that length of index hospital stays [Odds ratio (OR) =1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.036) and hyponatremia (OR = 1.85, 95% CI 1.06–3.24, P = 0.031) were independently associated with the rehospitalization. Multivariate Cox regression analysis indicated that 30-day rehospitalization was an independent risk factor for all-cause mortality [Hazard ratio (HR) =1.52, 95% CI 1.07–2.16, P = 0.019) and CVD mortality (HR = 1.73, 95% CI 1.03–2.90, P = 0.038). Conclusions The prevalence of 30-day unexpected rehospitalization for incident PD patients in our centre was 9.1%. The top three causes for the rehospitalization were PD-related peritonitis, catheter malfunction and severe fluid overload. Thirty-day unexpected rehospitalization increased the risk of all-cause mortality and CVD mortality for PD patients.

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“…Previous studies focusing on general pediatric diseases have demonstrated that the readmission rate is higher in young patients and in those born preterm. 10,40,43,47 Compared with older children, these groups of patients are considered more vulnerable to complications, resulting in a relatively lower threshold to admit these patients and, therefore, higher readmission rates. Furthermore, these patients have several associated conditions that might require a multidisciplinary team approach to determine physiological stability before discharge placement.…”

Section: Discussionmentioning

confidence: 99%

Unplanned readmission within 90 days after pediatric neurosurgery

Chotai¹,

Guidry²,

Chan³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEReadmission and return to operating room after surgery are increasingly being used as a proxy for quality of care. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in health care costs. The authors set out to analyze the incidence of readmission at their center, to define causes of unplanned readmission, and to determine the preoperative and surgical variables associated with readmissions following pediatric neurosurgery.METHODSA total of 536 children who underwent operations for neurosurgical diagnoses between 2012 and 2015 and who were later readmitted were included in the final analysis. Unplanned readmissions were defined to have occurred as a result of complications within 90 days after index surgery. Patient records were retrospectively reviewed to determine the primary diagnosis, surgery indication, and cause of readmission and return to operating room. The cost for index hospitalization, readmission episode, and total cost were derived based on the charges obtained from administrative data. Bivariate and multivariable analyses were conducted.RESULTSOf 536 patients readmitted in total, 17.9% (n = 96) were readmitted within 90 days. Of the overall readmissions, 11.9% (n = 64) were readmitted within 30 days, and 5.97% (n = 32) were readmitted between 31 and 90 days. The median duration between discharge and readmission was 20 days (first quartile [Q1]: 9 days, third quartile [Q3]: 36 days). The most common reason for readmission was shunt related (8.2%, n = 44), followed by wound infection (4.7%, n = 25). In the risk-adjusted multivariable logistic regression model for total 90-day readmission, patients with the following characteristics: younger age (p = 0.001, OR 0.886, 95% CI 0.824–0.952); “other” (nonwhite, nonblack) race (p = 0.024, OR 5.49, 95% CI 1.246–24.2); and those born preterm (p = 0.032, OR 2.1, 95% CI 1.1–4.12) had higher odds of being readmitted within 90 days after discharge. The total median cost for patients undergoing surgery in this study cohort was $11,520 (Q1: $7103, Q3: $19,264). For the patients who were readmitted, the median cost for a readmission episode was $8981 (Q1: $5051, Q3: $18,713).CONCLUSIONSUnplanned 90-day readmissions in pediatric neurosurgery are primarily due to CSF-related complications. Patients with the following characteristics: young age at presentation; “other” race; and children born preterm have a higher likelihood of being readmitted within 90 days after surgery. The median cost was > $8000, which suggests that the readmission episode can be as expensive as the index hospitalization. Clearly, readmission reduction has the potential for significant cost savings in pediatric neurosurgery. Future efforts, such as targeted education related to complication signs, should be considered in the attempt to reduce unplanned events. Given the single-center, retrospective study design, the results of this study are primarily applicable to this population and cannot necessarily be generalized to other institutions without further study.

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Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Cited by 15 publications

References 25 publications

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Burden and Correlates of Hospital Readmissions among U.S. Peritoneal Dialysis Patients

Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients

Unplanned readmission within 90 days after pediatric neurosurgery

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