Limits...
Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction.

Cohen S, Palazzi K, Marietti S, Kaplan G, Chiang G - Nephrourol Mon (2014)

Bottom Line: Readmission rates were compared using the Chi2 test.Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals.Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA.

ABSTRACT

Background: Bladder reconstruction in the pediatric population is challenging for many reasons, including perioperative complications and readmissions.

Objectives: On a national scale, determine readmission rates at 30, 60 and 90 days after bladder reconstruction in a pediatric population over a 7-year period, evaluating the influence of hospital and patient-specific variables.

Patients and methods: Using the Pediatric Health Information System database, we identified patients 0-17 years of age, from 2004-2010, undergoing bladder reconstruction using ICD-9 procedure codes. Descriptive statistics characterized demographics, prevalence of surgeries, and readmission rates. Surgery prevalence over time was examined using linear regression. Readmission rates were compared using the Chi2 test. Regression was used to evaluate the influence of variables on readmission risk.

Results: We identified 1,985 patients for inclusion, of which 52.7% were female. Median age was 9 years. There has been no change in the prevalence of bladder reconstruction surgeries (P = 0.327). There was no change in 30-day (P = 0.272), 60-day (P = 0.788) or 90-day readmission rates (P = 0.924). Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals. Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission.

Conclusions: No improvement in readmission rates after pediatric bladder reconstruction was observed during the study period. Nearly all centers have a similar readmission rate despite volume adjustment.

No MeSH data available.


Related in: MedlinePlus

Bladder Augmentation Prevalence From 2004-2010
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4318081&req=5

fig12799: Bladder Augmentation Prevalence From 2004-2010

Mentions: Over 7 years, there has been no change in the prevalence of bladder reconstruction surgeries (R2: 0.191, β coefficient: -4.71, 95% CI: -15.9 to 6.4, P = 0.327; Figure 1). There was no change in 30-day (ranging from 14% to 20% P = 0.272), 60-day (19% to 24%, P = 0.788) or 90-day readmission rates over time (23% to 27%, P = 0.924) (Table 2). Despite surgical volume adjustment, the majority of hospitals had similar 90-day readmission rates (Figure 2). From a total of 37 hospitals, two had significantly higher readmission rates/volume and three had significantly lower readmission rates/volume than the mean. The median cost for those patients requiring readmission was 1.76-fold higher than that of patients who were not readmitted based on RCC (P < 0.001).


Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction.

Cohen S, Palazzi K, Marietti S, Kaplan G, Chiang G - Nephrourol Mon (2014)

Bladder Augmentation Prevalence From 2004-2010
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318081&req=5

fig12799: Bladder Augmentation Prevalence From 2004-2010
Mentions: Over 7 years, there has been no change in the prevalence of bladder reconstruction surgeries (R2: 0.191, β coefficient: -4.71, 95% CI: -15.9 to 6.4, P = 0.327; Figure 1). There was no change in 30-day (ranging from 14% to 20% P = 0.272), 60-day (19% to 24%, P = 0.788) or 90-day readmission rates over time (23% to 27%, P = 0.924) (Table 2). Despite surgical volume adjustment, the majority of hospitals had similar 90-day readmission rates (Figure 2). From a total of 37 hospitals, two had significantly higher readmission rates/volume and three had significantly lower readmission rates/volume than the mean. The median cost for those patients requiring readmission was 1.76-fold higher than that of patients who were not readmitted based on RCC (P < 0.001).

Bottom Line: Readmission rates were compared using the Chi2 test.Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals.Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, UC San Diego Health System, University of California, San Diego, USA.

ABSTRACT

Background: Bladder reconstruction in the pediatric population is challenging for many reasons, including perioperative complications and readmissions.

Objectives: On a national scale, determine readmission rates at 30, 60 and 90 days after bladder reconstruction in a pediatric population over a 7-year period, evaluating the influence of hospital and patient-specific variables.

Patients and methods: Using the Pediatric Health Information System database, we identified patients 0-17 years of age, from 2004-2010, undergoing bladder reconstruction using ICD-9 procedure codes. Descriptive statistics characterized demographics, prevalence of surgeries, and readmission rates. Surgery prevalence over time was examined using linear regression. Readmission rates were compared using the Chi2 test. Regression was used to evaluate the influence of variables on readmission risk.

Results: We identified 1,985 patients for inclusion, of which 52.7% were female. Median age was 9 years. There has been no change in the prevalence of bladder reconstruction surgeries (P = 0.327). There was no change in 30-day (P = 0.272), 60-day (P = 0.788) or 90-day readmission rates (P = 0.924). Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals. Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission.

Conclusions: No improvement in readmission rates after pediatric bladder reconstruction was observed during the study period. Nearly all centers have a similar readmission rate despite volume adjustment.

No MeSH data available.


Related in: MedlinePlus