Leveraging the Incidence, Burden, and Fiscal Implications of Unplanned Hospital Revisits for the Prioritization of Prevention Efforts in Pediatric Surgery
Leveraging the Incidence, Burden, and Fiscal Implications of Unplanned Hospital Revisits for the Prioritization of Prevention Efforts in Pediatric Surgery
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DOI：
10.1097/sla.0000000000002885
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发表时间：
2020-01-01
影响因子：
9
通讯作者：
Rangel, Shawn J.
中科院分区：
文献类型：
--
作者：
Cameron, Danielle B.;Serres, Stephanie K.;Rangel, Shawn J.
目的：描述儿科手术中与复查相关的资源利用的程序级负担，目的是建立预防工作的优先级框架。背景数据总结：计划外的医院复诊对医疗保健系统来说是昂贵的，并且与患者及其家属的生产力损失有关。有限的客观数据存在，以指导在儿科手术的预防工作的优先顺序。研究方法：使用儿科健康信息系统（PHIS）数据库，对2012年1月1日至2015年3月31日期间47家儿童医院30种最常进行的儿科外科手术的30天计划外复诊进行了审查。如果预防措施成功实施，则计算每种手术对所有手术的再访相关住院时间和费用累积负担的相对贡献，作为公共卫生相关性的估计值（相对贡献越大=潜在公共卫生相关性越大）。结果：分析了159，675次指数接触，30天的总重访率为10.8%。四种手术占所有手术中一半以上的再访相关住院时间负担，相对贡献最高的是复杂性阑尾炎（18.4%）、胃造口术（13.4%）、无并发症阑尾炎（13.0%）和胃底折叠术（9.4%）。所有手术中，四种手术占了一半以上的翻修相关成本负担，其中相对贡献最高的是复杂性阑尾炎（18.8%）、胃造口术（14.6%）、胃底折叠术（10.4%）和无并发症阑尾炎（10.2%）。结论和相关性：在儿科手术中，少数手术造成了不成比例的复诊相关资源利用负担。胃造口术、胃底折叠术和阑尾切除术应被视为儿科手术中预防工作的高优先级目标。
Objective: To characterize procedure-level burden of revisit-associated resource utilization in pediatric surgery with the goal of establishing a prioritization framework for prevention efforts. Summary of Background Data: Unplanned hospital revisits are costly to the health care system and associated with lost productivity on behalf of patients and their families. Limited objective data exist to guide the prioritization of prevention efforts within pediatric surgery. Methods: Using the Pediatric Health Information System (PHIS) database, 30-day unplanned revisits for the 30 most commonly performed pediatric surgical procedures were reviewed from 47 children's hospitals between January 1, 2012 and March 31, 2015. The relative contribution of each procedure to the cumulative burden of revisit-associated length of stay and cost from all procedures was calculated as an estimate of public health relevance if prevention efforts were successfully applied (higher relative contribution = greater potential public health relevance). Results: 159,675 index encounters were analyzed with an aggregate 30-day revisit rate of 10.8%. Four procedures contributed more than half of the revisit-associated length of stay burden from all procedures, with the highest relative contributions attributable to complicated appendicitis (18.4%), gastrostomy (13.4%), uncomplicated appendicitis (13.0%), and fundoplication (9.4%). Four procedures contributed more than half of the revisit-associated cost burden from all procedures, with the highest relative contributions attributable to complicated appendicitis (18.8%), gastrostomy (14.6%), fundoplication (10.4%), and uncomplicated appendicitis (10.2%). Conclusions and Relevance: A small number of procedures account for a disproportionate burden of revisit-associated resource utilization in pediatric surgery. Gastrostomy, fundoplication, and appendectomy should be considered high-priority targets for prevention efforts within pediatric surgery.