Influence of Geographic Access on Surgical Center Readmissions After Index Congenital Heart Surgery

Pinto, Nelangi M.; Minich, L. LuAnn; Yoo, Minkyoung; Floyd, Alisha; Wilkes, Jacob; VanDerslice, James; Yamauchi, Melissa; Nelson, Richard E.

doi:10.1016/j.jpeds.2021.03.026

Cited by 7 publications

(3 citation statements)

References 41 publications

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“…Studies from other pediatric surgical conditions have reported 30-day unplanned readmission rates between 4 and 6% [17–19]. A recent large cohort study for congenital heart surgery found an incidence of 32% for unplanned readmissions within a 1-year period, similar to our rate of 29% for unplanned gastroschisis-related readmissions [20]. This may be because gastroschisis, like congenital heart malformations, is a more complex disease process that warrants more careful discharge planning and follow-up.…”

Section: Discussionsupporting

confidence: 81%

Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

Marquart¹,

Mukherjee²,

Canales³

et al. 2023

Fetal Diagn Ther

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Introduction: Gastroschisis is the most common congenital abdominal wall defect with a rising prevalence. Infants with gastroschisis are at risk for multiple complications, leading to a potential increased risk for hospital readmission after discharge. We aimed to find the frequency and factors associated with an increased risk of readmission. Methods: A retrospective analysis of infants born with gastroschisis between 2013 and 2019 who received initial surgical intervention and follow-up care in the Children’s Wisconsin health system was performed. The primary outcome was the frequency of hospital readmission within 1 year of discharge. We also compared maternal and infant clinical and demographic variables between those readmitted for reasons related to gastroschisis, and those readmitted for other reasons or not readmitted. Results: Forty of 90 (44%) infants born with gastroschisis were readmitted within 1-year of the initial discharge date, with 33 (37%) of the 90 infants being readmitted due to reasons directly related to gastroschisis. The presence of a feeding tube (p < 0.0001), a central line at discharge (p = 0.007), complex gastroschisis (p = 0.045), conjugated hyperbilirubinemia (p = 0.035), and the number of operations during the initial hospitalization (p = 0.044) were associated with readmission. Maternal race/ethnicity was the only maternal variable associated with readmission, with Black race being less likely to be readmitted (p = 0.003). Those who were readmitted were also more likely to be seen in outpatient clinics and utilize emergency healthcare resources. There was no statistically significant difference in readmission based on socioeconomic factors (all p > 0.084). Conclusion: Infants with gastroschisis have a high hospital readmission rate, which is associated with a variety of risk factors including complex gastroschisis, multiple operations, and the presence of a feeding tube or central line at discharge. Improved awareness of these risk factors may help stratify patients in need of increased parental counseling and additional follow-up.

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Section: Discussionsupporting

confidence: 81%

Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

Marquart¹,

Mukherjee²,

Canales³

et al. 2023

Fetal Diagn Ther

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“…The relationship between demographic and geographic factors and access to specialist CHD services has been well defined in a surgical context. Patients who have more severe CHD, private health insurance, and shorter driving times are more likely to present to specialist cardiac surgery centres [ 42 ] and greater distances from CHD centres results in CHD patients having surgery at non-specialist clinics [ 43 ] Of those who do attend specialist CHD surgical centres, living further away is associated with a longer length of stay, more complications, and higher cost [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

An interactive geographic information system to inform optimal locations for healthcare services

2023

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Large health datasets can provide evidence for the equitable allocation of healthcare resources and access to care. Geographic information systems (GIS) can help to present this data in a useful way, aiding in health service delivery. An interactive GIS was developed for the adult congenital heart disease service (ACHD) in New South Wales, Australia to demonstrate its feasibility for health service planning. Datasets describing geographic boundaries, area-level demographics, hospital driving times, and the current ACHD patient population were collected, linked, and displayed in an interactive clinic planning tool. The current ACHD service locations were mapped, and tools to compare current and potential locations were provided. Three locations for new clinics in rural areas were selected to demonstrate the application. Introducing new clinics changed the number of rural patients within a 1-hour drive of their nearest clinic from 44·38% to 55.07% (79 patients) and reduced the average driving time from rural areas to the nearest clinic from 2·4 hours to 1·8 hours. The longest driving time was changed from 10·9 hours to 8·9 hours. A de-identified public version of the GIS clinic planning tool is deployed at https://cbdrh.shinyapps.io/ACHD_Dashboard/. This application demonstrates how a freely available and interactive GIS can be used to aid in health service planning. In the context of ACHD, GIS research has shown that adherence to best practice care is impacted by patients’ accessibility to specialist services. This project builds on this research by providing opensource tools to build more accessible healthcare services.

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“…Income was then categorized into quartiles. Zip code was also used to assess whether patients lived in rural, urban, or small town environments, using the Rural-Urban Commuting Area codes [26,27]. Imaging examinations performed were identified by querying our institutional database using the appropriate Current Procedural Terminology codes to identify those who underwent a hip or knee X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) scan with an associated diagnosis of hip or knee OA after or at the same time as their initial OA diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in the Imaging Workup and Treatment of Knee and Hip Osteoarthritis

Case

Kim

et al. 2022

The Journal of Arthroplasty

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Influence of Geographic Access on Surgical Center Readmissions After Index Congenital Heart Surgery

Cited by 7 publications

References 41 publications

Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis

An interactive geographic information system to inform optimal locations for healthcare services

Racial and Ethnic Disparities in the Imaging Workup and Treatment of Knee and Hip Osteoarthritis

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