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Background: Hospital readmission is increasingly being targeted as a marker for quality of care and reimbursement reform. The purpose of this study was to characterize epidemiological trends and cost implications of hospital readmission following treatment of pediatric appendicitis.
Methods: We conducted a five-year retrospective cohort analysis of 30-day readmission rates ( ED or inpatient) for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postop LOS?2 days) or "complicated" (LOS?3 days and ?4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters.
Results: The aggregate 30-day readmission rate was 8.7% and this varied significantly by disease severity and management approach (uncomplicated appendectomy:5.6%, complicated appendectomy:12.8%; drainage:22.6%; antibiotics only:24.6%, p<0.0001). The median hospital cost per case attributable to readmission was \,401 (reflecting a 44% relative increase in cumulative treatment-related cost), and this varied significantly by disease severity and management approach (uncomplicated appendectomy:\,946 [31% relative increase]; complicated appendectomy:\,524 [53% increase]; drainage:\,827 [48% increase]; antibiotics only:\,835 [58% increase], p<0.0001).
Conclusion: In freestanding children's hospitals, readmission following treatment for pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment and hospital-related risk factors as a basis for developing preventative strategies.