Mears Alice Louise, Bisharat May, Murphy Feilim, Sinha Chandrasen K
Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Department of Paediatric Surgery, St George's University Hospitals NHS Foundation, Trust, London, UK.
Pediatr Surg Int. 2019 May;35(5):597-602. doi: 10.1007/s00383-019-04449-6. Epub 2019 Feb 18.
Following a previously published 1 year audit of readmissions, this is a reaudit of our readmission rate (ReAd) in paediatric surgery, asking: is ReAd reproducible, can it be an indicator of quality of care in paediatric surgery, and can it be improved?
Prospectively collected Hospital Episode statistics were used to identify readmissions over 1 year. Patients were subdivided into emergency vs elective regarding the first admission and outcomes compared including with our previously published ReAd data.
2616 children (67% male) were admitted during 2016: 1398 (53%) elective and 1218 (47%) emergency admissions. The overall ReAd was 0.9%, comparable to and lower than our previously published rate of 2%. The commonest cause for readmission was appendicitis-related (22%). The emergency cohort ReAd was 1.5% (18/1218) compared to 0.4% (5/1398) in the elective cohort, 4× higher (p = 0.002). In the emergency cohort, the commonest causes for readmission were abdominal pain and perforated appendicitis. 80% of elective group readmissions were related to urological procedures. More of these required surgical intervention to treat (80% vs 22%) (p = 0.03).
(1) ReAd is a reproducible and reducible quality-of-care indicator in paediatric surgery. (2) Emergency admission is a risk factor for readmission. (3) Appendicectomy was associated with the highest ReAd.
继之前发表的关于再入院情况的1年审计报告之后，本次对我们小儿外科的再入院率（ReAd）进行重新审计，提出以下问题：ReAd是否具有可重复性，它能否作为小儿外科护理质量的指标，以及它能否得到改善？
前瞻性收集医院病历统计数据，以确定1年内的再入院情况。根据首次入院情况将患者分为急诊组和择期组，并比较结果，包括与我们之前发表的ReAd数据进行比较。
2016年期间有2616名儿童入院（67%为男性）：1398例（53%）为择期入院，1218例（47%）为急诊入院。总体再入院率为0.9%，与我们之前发表的2%的比率相当且更低。再入院最常见的原因与阑尾炎相关（22%）。急诊组的再入院率为1.5%（18/1218），而择期组为0.4%（5/1398），前者是后者的4倍（p = 0.002）。在急诊组中，再入院最常见的原因是腹痛和穿孔性阑尾炎。择期组80%的再入院与泌尿外科手术有关。其中更多病例需要手术干预来治疗（80%对22%）（p = 0.03）。
（1）ReAd是小儿外科中一个具有可重复性且可降低的护理质量指标。（2）急诊入院是再入院的一个风险因素。（3）阑尾切除术与最高的再入院率相关。
