Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT.
J Pediatr. 2021 Jul;234:195-204.e3. doi: 10.1016/j.jpeds.2021.03.026. Epub 2021 Mar 24.
To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.
Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression.
Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days.
Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population.
评估手术中心地理位置对儿童先心病术后再入院风险和负担的影响。
利用儿科健康信息系统（PHIS）数据（2004-2015 年，46 家医院），确定出院时年龄<6 岁的先心病患儿（风险调整后先心病手术评分 2-6 分）。使用邮政编码中心点计算患者与手术中心的居住距离，分为<15、15-29、30-59、60-119 和≥120 英里。采用城乡通勤区代码来定义农村-城市属性。利用多变量回归分析手术中心计划外再入院的地理风险因素及其相关负担（总住院时长、费用和并发症）。
在 59696 名合格患儿中，19355 名（32%）至少有 1 次计划外再入院。整个队列的平均住院时长为 9 天（IQR 22）。在再入院患儿中，总费用中位数为 31559 美元（IQR 90176 美元）。距离手术中心越远，再入院风险越低，但农村属性越高，再入院风险越高。在再入院患儿中，距离增加与住院时间延长、并发症增多和费用增加相关。与城市患儿相比，高度农村患儿计划外再入院的可能性更高，但平均再入院天数更少。
手术中心地理位置的地理指标对再入院到手术中心的情况有不同影响。距离手术中心越远，计划外再入院的可能性越低，但并发症越多。在再入院患儿中，最偏远地区的患儿再入院费用最高。了解地理位置的影响有助于制定改善该人群医疗服务的策略。
