Arlen Angela M, Merriman Laura S, Heiss Kurt F, Cerwinka Wolfgang H, Elmore James M, Massad Charlotte A, Smith Edwin A, Broecker Bruce H, Scherz Hal C, Kirsch Andrew J
Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
J Pediatr Urol. 2014 Aug;10(4):712-6. doi: 10.1016/j.jpurol.2013.09.028. Epub 2013 Oct 31.
Reducing readmissions has become a focal point to increase quality of care while reducing costs. We report all-cause unplanned return visits following urologic surgery in children at our institution.
Children undergoing urology procedures with returns within 30 days of surgery were identified. Patient demographics, insurance status, type of surgery, and reason for return were assessed.
Four thousand and ninety-seven pediatric urology surgeries were performed at our institution during 2012, with 106 documented unplanned returns (2.59%). Mean time from discharge to return was 5.9 ± 4.9 days (range, 0.3-24.8 days). Returns were classified by chief complaint, including pain (32), infection (30), volume status (14), bleeding (11), catheter concern (8), and other (11). Circumcision, hypospadias repair, and inguinal/scrotal procedures led to the majority of return visits, accounting for 21.7%, 20.7%, and 18.9% of returns, respectively. Twenty-two returns (20.75%) resulted in hospital readmission and five (4.72%) required a secondary procedure. Overall readmission rate was 0.54%, with a reoperation rate of 0.12%.
The rate of unplanned postoperative returns in the pediatric population undergoing urologic surgery is low, further strengthening the argument that readmission rates in children are not necessarily a productive focal point for financial savings or quality control.
减少再入院率已成为提高医疗质量同时降低成本的一个焦点。我们报告了我院儿童泌尿外科手术后因各种原因的非计划重返情况。
确定在手术后30天内有重返情况的接受泌尿外科手术的儿童。评估患者的人口统计学特征、保险状况、手术类型及重返原因。
2012年我院共进行了4097例小儿泌尿外科手术，其中有106例记录的非计划重返（2.59%）。出院至重返的平均时间为5.9±4.9天（范围0.3 - 24.8天）。重返情况按主要诉求分类，包括疼痛（32例）、感染（30例）、容量状态（14例）、出血（11例）、导管相关问题（8例）及其他（11例）。包皮环切术、尿道下裂修复术及腹股沟/阴囊手术导致的重返情况占多数，分别占重返总数的21.7%、20.7%和18.9%。22例重返（20.75%）导致再次入院，5例（4.72%）需要二次手术。总体再入院率为0.54%，再次手术率为0.12%。
接受泌尿外科手术的儿童人群中术后非计划重返率较低，这进一步支持了儿童再入院率不一定是节省资金或质量控制有效焦点的观点。
