Just six pediatric procedures from two pediatric subspecialties accounted for most post-surgery hospital and emergency department (ED) visits in a comprehensive analysis led by researchers at Ann & Robert H. Lurie Children’s Hospital of Chicago. The study was published online in August in JAMA (the Journal of the American Medical Association.)
The six otolaryngology and general pediatric surgery procedures — tonsillectomy/adenoidectomy, appendectomy, central venous catheter (CVC)/port insertion, gastrostomy, myringotomy/tympanostomy (ear tube insertion) and circumcision — accounted for 68% of 88,796 revisits to the hospital within 30 days of discharge following surgery. Tonsillectomy/adenoidectomy had the highest number of revisits total – 18,279 revisits out of 88,796. Meanwhile, CVC/port insertion has the highest revisit rate, with 41%.
The study authors, including Fizan Abdullah, MD, Division Head of Pediatric Surgery at Lurie Children’s, used data from the Pediatric Health Information System (PHIS) to analyze more than 1 million procedures across 9 surgical subspecialties performed at 52 children’s hospitals nationwide. The study uses recent data from January 2016 – January 2020.
"We wanted to identify surgeries at high risk for revisits so that strategies for avoiding the emergency room and improving outcomes can be implemented,” Dr. Abdullah said.
Additionally, pediatric hospitals are likely to face penalties when patients revisit the hospital for unscheduled care following procedures, similar to what adult hospitals currently face. This research may help institutions examine where they can improve processes and safety/quality control efforts to avoid those fines.
“Our study results are also important in that we already know that revisits after children’s surgery take a tremendous financial toll on the health system,” said study co-author and health economist Dr. Hassan Ghomrawi. “The high levels of revisit rates in just a few procedures present a tremendous opportunity to change how we do the business of children’s surgery.”
Previous similar analyses were performed using older data that point to the same list of procedures, researchers said.
“Despite improvements in care, this study shows that we may have reached a plateau in how we can manage postoperative care using current strategies,” Dr. Ghomrawi said.
Added Dr. Abdullah, “The current paradigm of postoperative care needs to fundamentally change, providing the clinical team insights into the patient’s recovery beyond hospital discharge. Remote monitoring of patients postoperatively anticipates complications and the need for care and has proven to reduce ED visits and revisits. This technology has been used on a small proportion of patients, but with the explosion of digital technologies, remote monitoring has become more widely available and could serve this purpose.”
About Ann & Robert H. Lurie Children’s Hospital of Chicago
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine.