Goldin Adam B, Heiss Kurt F, Hall Matt, Rothstein David H, Minneci Peter C, Blakely Martin L, Browne Marybeth, Raval Mehul V, Shah Samir S, Rangel Shawn J, Snyder Charles L, Vinocur Charles D, Berman Loren, Cooper Jennifer N, Arca Marjorie J
Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
J Pediatr. 2016 Jul;174:139-145.e2. doi: 10.1016/j.jpeds.2016.03.032. Epub 2016 Apr 11.
To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals.
This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression. A subgroup analysis was performed comparing patients having the GT placed on the date of admission or later in the hospital course.
Of 15 642 identified patients, 8.6% had an ED visit within 30 days of hospital discharge, and 3.9% were readmitted through the ED with a GT-related issue. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, Hispanic ethnicity, non-Hispanic black race, and the presence of ≥3 chronic conditions were independently associated with ED revisits; gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission. Timing of GT placement (scheduled vs late) was not associated with either ED revisits or hospital readmission.
GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of nonmodifiable risk factors such as race/ethnicity and medical complexity is an initial step toward understanding this population so that interventions can be developed to decrease these potentially preventable occurrences given their importance among accountable care organizations.
确定38家独立儿童医院中，所有手术科室（外科、介入放射科、胃肠病科）在小儿胃造口管（GT）置入术后30天内急诊室（ED）就诊及再入院的发生率。
这项回顾性队列研究评估了2010年至2012年间接受GT置入术后出院的18岁以下患者。采用多变量逻辑回归分析确定与出院后30天内急诊复诊和再入院显著相关的因素。对入院当天或住院过程中更晚时间置入GT的患者进行亚组分析。
在15642例确诊患者中，8.6%在出院后30天内到急诊室就诊，3.9%因GT相关问题通过急诊室再次入院。与这些就诊相关的GT相关事件包括感染（27%）、机械并发症（22%）和更换（19%）。在多变量分析中，西班牙裔、非西班牙裔黑人种族以及存在≥3种慢性病与急诊复诊独立相关；胃食管反流以及在GT置入时未同时进行胃底折叠术与再入院独立相关。GT置入时间（计划内与晚期）与急诊复诊或再入院均无关。
GT置入与出院后前30天内急诊复诊和再入院的高发生率相关。种族/民族和医疗复杂性等不可改变的风险因素之间的关联是了解这一人群的第一步，鉴于其在 accountable care organizations中的重要性，因此可以制定干预措施以减少这些潜在的可预防事件。
