Emergency room visits and readmissions after pediatric urologic surgery

Arlen, Angela M.; Merriman, Laura S.; Heiss, Kurt F.; Cerwinka, Wolfgang H.; Elmore, James M.; Massad, Charlotte A.; Smith, Edwin A.; Broecker, Bruce H.; Scherz, Hal C.; Kirsch, Andrew J.

doi:10.1016/j.jpurol.2013.09.028

Cited by 27 publications

(23 citation statements)

References 14 publications

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“…While the return rate to the ED after pediatric surgery varies widely in the literature from 2.3% to 18.9% with a readmission rate of 0.78–16.5% [4–11], our findings were similar to the findings of Arlen et al [12], who reported a 2.59% return rate, 0.54% readmission rate, and 0.12% reoperative rate. Other studies found race and insurance status to predict return to the ED or readmission, but this was not true of our population [5,13–15].…”

Section: Discussionsupporting

confidence: 89%

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Shepard

Wan

2017

Journal of Pediatric Urology

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Summary Introduction More pediatric patients seem to present to the emergency department (ED) for non-urgent matters after urologic procedures than adult patients. Under new and expanding healthcare reform, pediatric urologists may be penalized for these visits. We compare our 30-day postoperative bounceback rates to the ED and the acuity of the concerns in these populations. Materials and methods All urology consults at our institution are maintained on a prospectively tracked database. We identified all patients who presented to our adult or pediatric ED between July 2013 and June 2015 within 30 days of a urologic procedure. We investigated the patient demographics including age, race, insurance, distance from the home zip code to the ED, procedures performed, chief complaint in the ED, diagnosis, and treatment required. Results In our pediatric group, there were 67 visits for 56 patients (19 female, 37 male, mean age 6.8 years), which represents an overall bounceback incidence of 2.7%. Of those, 19% required admission (0.60% overall readmission rate), 10% underwent a procedure (0.32% reoperative rate, 18% required catheter manipulation/placement, 13% were given a prescription (most commonly for constipation), 6% required local wound care, and 33% were reassured only. Most pediatric patients had private insurance (62.5%) and those with private insurance or who were uninsured tended to require only reassurance compared to those with Medicare/Medicaid (p = 0.053). In the adult population, there were 369 visits in 310 patients (111 female, 199 male, mean age 55.4 years) for an incidence of 4.4%. Of those, 42% were admitted (2.2% overall readmission rate), 14% underwent a procedure (0.74% reoperative rate), 11% required catheter manipulation/placement, 14% were given medication (most commonly antibiotics and narcotics), 4% were given local wound care, and 12% were reassured. Most adult patients had Medicare/Medicaid (48.7%), but insurance type was not related to treatment required (p = 0.382). On multivariable analysis, pediatric patients, closer proximity to the hospital, and earlier postoperative day at presentation to the ED were predictive of requiring only reassurance. Conclusions Compared to adults, pediatric patients are less likely to return to the ED postoperatively (p < 0.001), but they are significantly more likely to require only reassurance (p < 0.001) while adults are significantly more likely to require hospital admission (p < 0.001). In both groups, nearly one-third of patients required only catheter care or medication. This difference could have significant implications for new healthcare policy.

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Section: Discussionsupporting

confidence: 89%

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Shepard

Wan

2017

Journal of Pediatric Urology

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“…The low readmission rates seen in our study closely track readmission rates in other pediatric surgical populations: 2.6% in pediatric general surgery and 3.5% in pediatric urology patients . Although the global pediatric ENT readmission rate was relatively low, there was a range of readmission rates that varied between each procedure group (Table 1).…”

Section: Discussionsupporting

confidence: 70%

Frequency and cause of readmissions following pediatric otolaryngologic surgery

2015

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Readmissions after pediatric otolaryngologic surgery are relatively uncommon. These readmission rates vary directly with the type of procedure performed, as well as patient level factors (i.e., patient age, ethnicity, and the presence of other medical comorbidities). These data demonstrate that if readmission rates are to be used as a quality measure in pediatric otolaryngology procedures, complex risk adjustment of patient level variables will be necessary to accurately compare outcomes between different hospitals.

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“…A similar concept was mentioned by Arlen et al, who stated that additional educational resources may also serve to alert caregivers to signs and symptoms that warrant prompt intervention (e.g., bleeding that requires intervention or infections that need additional assessment). 4 Stalberg et al evaluated the use of email communications initiated by the patient in the perioperative time period for elective thyroid surgery. 12 They noted improved communication between patient and surgeon with no apparent decrease in measured satisfaction.…”

Section: Digital Communication and Postoperative Er Visitsmentioning

confidence: 99%

“…Despite simplifications of the dressing, as well as efforts to provide support to the caregivers, penile surgery remains one of the most common pediatric urological procedures that leads to emergency room (ER) visits. 3,4 One of the reasons for ER visits may due to the anxiety and uncertainty of caregivers on the postoperative wound appearance that would suggest infection or inadequate healing (discoloration or excessive swelling). 4 Smartphones and the internet have become widely accessible commodities worldwide, making email a feasible method of communication between a patient's family and healthcare provider.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 One of the reasons for ER visits may due to the anxiety and uncertainty of caregivers on the postoperative wound appearance that would suggest infection or inadequate healing (discoloration or excessive swelling). 4 Smartphones and the internet have become widely accessible commodities worldwide, making email a feasible method of communication between a patient's family and healthcare provider. 5,6 A recent study by Turk et al showed that photos from caregivers' video cameras for the followup assessment of children post-hypospadias repair decrease hospital anxiety for children and reduce clinic time at followup visits.…”

Section: Introductionmentioning

confidence: 99%

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Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair

Chua

Saunders

Bowlin

et al. 2017

CUAJ

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Introduction: Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. Methods: This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at p<0.05. Results: Over a 14-month period, 96 patients underwent hypospadias repair (81 in Group A, 15 in Group B 5). No significant difference was noted between groups for overall ER return rate (RR 0.46, 95% CI 0.21, 1.0). However, the number of ER visits for wound check not requiring intervention was significantly lower in Group A than in Group B (RR 0.14, 95% CI 0.035, 0.56); likewise, a higher number of ER visits requiring intervention was noted in Group A compared with Group B, although statistically this was not significant (RR 1.67, 95% CI 0.23, 12.21). Conclusions: Email communication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

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Emergency room visits and readmissions after pediatric urologic surgery

Cited by 27 publications

References 14 publications

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Frequency and cause of readmissions following pediatric otolaryngologic surgery

Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair

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