Case Volume and Revisits in Children Undergoing Gastrostomy Tube Placement

Arca, M. J.; Rangel, S. J.; Hall, M.; Rothstein, D. H.; Blakely, M. L.; Minneci, P. C.; Shah, S. S.; Heiss, K. F.; Snyder, C. L.; Berman, L.; Browne, M.; Vinocur, C. D.; Raval, M. V.; Goldin, A. B.

J Pediatr Gastroenterol Nutr. 2017 Jan 21

Abstract

OBJECTIVE: Emergency department (ED) visits and hospital readmissions are common following gastrostomy tube (GT) placement in children. We sought to characterize inter-hospital variation in revisit rates and explore the association between this outcome and hospital-specific GT case volume. STUDY DESIGN: We conducted a retrospective cohort study from 38 hospitals using the Pediatric Health Information System (PHIS) database. Patients <18 years who had a GT placed in 2010-2012 were assessed for a GT-related (mechanical or infectious) ED visit or inpatient readmission at 30 and 90 days following discharge from GT placement. Risk-adjusted rates were calculated using generalized linear mixed effects models accounting for hospital clustering and relevant demographic and clinical attributes, then compared across hospitals. RESULTS: 15,642 patients were included. A median of 468 GT were placed /hospital/3 years;(range 83-891), with a median of 11.4 GT placed per 1,000 discharges (range 2.4-16.7). Median ED visit for each hospital at 30-days post-discharge was 8.2% (range: 3.7-17.2%) and 14.8% at 90 days (range: 6.3-26.1%). Median inpatient readmissions for each hospital at 30-days post discharge was 3.5%, (range: 0.5-10.5%) and 5.9% at 90-days (range: 1.0-18.5%). Hospital specific GT placement per 1,000 discharges (rate of GT placement) was inversely correlated with ED visit rates at 30 days (p = 0.007) and 90 days (p = 0.020). The adjusted 30- and 90-day readmission rate and the adjusted 30 and 90 day ED return rates decreased with increasing GT insertion rate (p < 0.001). CONCLUSION: Higher hospital GT insertion rates are associated with lower ED revisit rates but not inpatient readmissions.

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