Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60614, USA.
J Pediatr Surg. 2011 Oct;46(10):1918-22. doi: 10.1016/j.jpedsurg.2011.04.012.
The readmission rate after pediatric appendectomy is frequently reported in clinical outcomes studies and quality improvement initiatives without proper description. Our aim was to delineate the context and significance of these encounters.
Patients (<18 years old) who underwent appendectomy for acute appendicitis at a tertiary children's hospital from January 2007 through June 2010 were reviewed. Emergency department (ED) visits and inpatient readmissions within 90 days were identified and classified as unrelated, related surgical complications, or potentially avoidable visits for minor related concerns.
Of 629 patients, 119 (18.9%) had 141 ED visits or readmissions within 90 days after discharge. Eighty-three (58.9%) encounters were limited to the ED, and 58 (41.1%) required inpatient hospitalization. Eighty-seven percent of encounters within the first 30 days after discharge, but only 26% of those occurring beyond 30 days, were related to the operation (P < .001). Overall, 45 (31.9%) ED visits or readmissions were totally unrelated to the appendectomy, 36 (25.5%) represented true surgical complications requiring inpatient hospitalization, and 60 (42.6%) were minor, potentially avoidable visits related to the appendectomy. Potentially avoidable encounters were more common in Spanish-speaking patients (P < .01).
Emergency department visits and inpatient readmissions after pediatric appendectomy are frequent but not uniformly indicative of surgical complications or suboptimal care. Opportunities exist to reduce avoidable ED visits related to minor postoperative concerns.
儿科阑尾切除术的再入院率经常在临床结果研究和质量改进计划中报告，但没有适当的描述。我们的目的是阐明这些情况的背景和意义。
回顾了 2007 年 1 月至 2010 年 6 月在一家三级儿童医院因急性阑尾炎行阑尾切除术的患者。确定了 90 天内的急诊就诊和住院再入院，并将其分类为无关、相关手术并发症或因轻微相关问题而可避免的就诊。
在 629 例患者中，有 119 例（18.9%）在出院后 90 天内出现 141 次急诊就诊或再入院。83 例（58.9%）就诊仅局限于急诊，58 例（41.1%）需要住院治疗。出院后 30 天内的就诊中，87%与手术相关，但超过 30 天的就诊中只有 26%与手术相关（P<0.001）。总体而言，45 例（31.9%）急诊就诊或再入院与阑尾切除术完全无关，36 例（25.5%）代表需要住院治疗的真正手术并发症，60 例（42.6%）是与阑尾切除术相关的轻微、可避免的就诊。西班牙语患者更容易出现可避免的就诊（P<0.01）。
儿科阑尾切除术后的急诊就诊和住院再入院很常见，但并不都表明手术并发症或护理不佳。有机会减少与轻微术后问题相关的可避免的急诊就诊。
