Cameron Danielle B, Graham Dionne A, Milliren Carly E, Serres Stephanie, Glass Charity C, Goldin Adam B, Rangel Shawn J
Department of Surgery, Boston Children's Hospital - Harvard Medical School, Boston, MA.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
J Pediatr Surg. 2017 Jun;52(6):1050-1055. doi: 10.1016/j.jpedsurg.2017.03.034. Epub 2017 Mar 18.
The purpose of this study was to compare the relatedness of revisits to the index surgical encounter across different pediatric surgical procedures and to explore whether all-cause revisit rates are an accurate surrogate measure for related revisits in this cohort of children.
We reviewed all-cause revisits occurring within ninety days of the thirty most commonly performed pediatric surgical procedures at 44 children's hospitals between 1/1/2012 and 3/31/2015. For each condition, a team of four surgeons reviewed revisit diagnoses and reached consensus around relatedness to the index surgical encounter. Chi-squared tests were used to test for variation in all-cause and related revisits among procedures. Spearman's correlation coefficient was used to measure the association between rankings of procedures by their all-cause and related revisit rates.
144,535 index encounters were analyzed with an overall revisit rate of 15.0% (21,732). Significant variation was found in both the rates of all-cause revisits among procedures (ranges: 7.6-68.4%, p<0.0001), and in the relative proportions of revisits related the index surgical encounter (range: 0% to 77%, p<0.0001). Poor correlation was found between procedure rankings based on all-cause revisit rates and revisit rates related to the index admission (r=0.33, p=0.07).
The relative proportion of revisits related to the index encounter varies significantly across pediatric surgical conditions, and poor correlation exists at the procedure-level between all-cause and related revisits rates.
IV.
本研究旨在比较不同小儿外科手术再次就诊与初次手术的相关性，并探讨全因再次就诊率是否是该队列儿童相关再次就诊的准确替代指标。
我们回顾了2012年1月1日至2015年3月31日期间44家儿童医院30种最常见小儿外科手术术后90天内的全因再次就诊情况。对于每种疾病，由四名外科医生组成的团队对再次就诊诊断进行审查，并就与初次手术的相关性达成共识。采用卡方检验来检验不同手术之间全因再次就诊和相关再次就诊的差异。使用斯皮尔曼相关系数来衡量根据全因再次就诊率和相关再次就诊率对手术进行排名之间的关联。
共分析了144,535例初次就诊病例，总体再次就诊率为15.0%（21,732例）。发现不同手术的全因再次就诊率（范围：7.6 - 68.4%，p<0.0001）以及与初次手术相关的再次就诊相对比例（范围：0%至77%，p<0.0001）均存在显著差异。基于全因再次就诊率的手术排名与与初次入院相关的再次就诊率之间的相关性较差（r = 0.33，p = 0.07）。
不同小儿外科疾病中与初次就诊相关的再次就诊相对比例差异显著，在手术层面上，全因再次就诊率和相关再次就诊率之间的相关性较差。
IV级。
