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Background: The purpose was 1) To characterize factors predictive of readmission following treatment for appendicitis, and 2) Development of a risk-adjusted model for comparative analysis of readmission rates between hospitals as a basis for collaborative quality improvement.
Methods: Retrospective audit of 52,054 patients with appendicitis at 38 children's hospitals. Cases were defined as uncomplicated (LOS?2days) and complicated (LOS?3 days and ?4 consecutive days of antibiotics) and analyzed using univariate and multivariate analysis to determine predictors of 30-day readmission.
Results: 4,213 patients were readmitted during the study period. Univariate analysis revealed significant differences between readmitted and non-readmitted groups in the distribution of age (p<0.001), payer status (p<0.001), intervention (p<0.001), and severity of disease (p<0.001). Multivariate modeling showed complicated disease to be a strong predictor of readmission (vs. uncomplicated: OR 2.41 [95%CI:2.15-2.7], p<0.0001) as well as public insurance (vs. nonpublic: OR 1.14 [95%CI:1-1.29], p<0.0455) and black racial status (vs. white: OR 1.22 [95%CI:1.03-1.45], p=0.0222). Following risk-adjustment, the relative rankings of 87% of centers changed (average change: 2.8 rank positions, range of change: 0-9 rank positions). Comparing adjusted readmission rates for patients with complicated disease and patients with uncomplicated disease, 6 institutions had consistently lower readmission rates (Figure).
Conclusion: Comparative analysis of readmission rates through a risk-adjusted platform could provide an effective means for the development of collaborative quality improvement efforts to reduce preventable readmissions and associated cost.