Department of Surgery, Boston Children's Hospital-Harvard Medical School, Boston, MA.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA.
Ann Surg. 2020 Jan;271(1):191-199. doi: 10.1097/SLA.0000000000002885.
To characterize procedure-level burden of revisit-associated resource utilization in pediatric surgery with the goal of establishing a prioritization framework for prevention efforts.
Unplanned hospital revisits are costly to the health care system and associated with lost productivity on behalf of patients and their families. Limited objective data exist to guide the prioritization of prevention efforts within pediatric surgery.
Using the Pediatric Health Information System (PHIS) database, 30-day unplanned revisits for the 30 most commonly performed pediatric surgical procedures were reviewed from 47 children's hospitals between January 1, 2012 and March 31, 2015. The relative contribution of each procedure to the cumulative burden of revisit-associated length of stay and cost from all procedures was calculated as an estimate of public health relevance if prevention efforts were successfully applied (higher relative contribution = greater potential public health relevance).
159,675 index encounters were analyzed with an aggregate 30-day revisit rate of 10.8%. Four procedures contributed more than half of the revisit-associated length of stay burden from all procedures, with the highest relative contributions attributable to complicated appendicitis (18.4%), gastrostomy (13.4%), uncomplicated appendicitis (13.0%), and fundoplication (9.4%). Four procedures contributed more than half of the revisit-associated cost burden from all procedures, with the highest relative contributions attributable to complicated appendicitis (18.8%), gastrostomy (14.6%), fundoplication (10.4%), and uncomplicated appendicitis (10.2%).
A small number of procedures account for a disproportionate burden of revisit-associated resource utilization in pediatric surgery. Gastrostomy, fundoplication, and appendectomy should be considered high-priority targets for prevention efforts within pediatric surgery.
描述儿科手术中与复诊相关的资源利用的程序层面负担，以期建立预防工作的优先框架。
计划外的医院复诊给医疗保健系统带来了高昂的成本，并且给患者及其家属的生产力带来了损失。儿科手术中，针对预防工作的优先级排序，仅有有限的客观数据可用于指导。
使用儿科健康信息系统（PHIS）数据库，我们回顾了 2012 年 1 月 1 日至 2015 年 3 月 31 日期间，47 家儿童医院 30 种最常见的儿科手术的 30 天内非计划性复诊情况。通过计算每种手术对所有手术复诊相关住院时间和费用负担的累积贡献，来评估其对公共卫生的相关性（贡献越高，公共卫生相关性越强）。
分析了 159675 例索引就诊，总体 30 天复诊率为 10.8%。有 4 种手术导致了所有手术复诊相关住院时间负担的一半以上，其中贡献最高的是复杂性阑尾炎（18.4%）、胃造口术（13.4%）、单纯性阑尾炎（13.0%）和胃底折叠术（9.4%）。4 种手术导致了所有手术复诊相关费用负担的一半以上，其中贡献最高的是复杂性阑尾炎（18.8%）、胃造口术（14.6%）、胃底折叠术（10.4%）和单纯性阑尾炎（10.2%）。
少数手术导致了儿科手术中与复诊相关的资源利用的不成比例负担。胃造口术、胃底折叠术和阑尾切除术应被视为儿科手术中预防工作的重点目标。
