Login to Access Video or Poster Abstract: MP96-19
Sources of Funding: none

Introduction

Unplanned postoperative return to emergency department (ED) and readmission represent a quality bench outcome and pose a considerable cost burden for health care systems. Here we evaluate a free-standing tertiary care children&[prime]s hospital to identify potential causes and explore areas for improvement.

Methods

A Quality Improvement Board approved retrospective study was performed in our institution identifying all surgical cases done under the service of Urology from October 2012 to September 2015. Baseline demographics, surgeon, operation type and duration, ASA class, and type of admission were evaluated. Patients who returned to ED within 30 days from surgery date were identified. The ED records were reviewed for time of ED return, reason for visit, and treatment received. Univariate and multivariate statistical analysis were done to identify variables that are associated with ED return. Odds ratio (OR) and 95% confidence Intervals (95%CI) were generated to determine the magnitude of relationships.

Results

A total of 4125 surgical cases were performed. Overall mean age was 59.9 months (SEM 0.94); with 85.1% of the patients were males. Three hundred forty-nine (8.5%) had unplanned return to the ED within 30 days from the surgery. 15.2% (53) of these returned patients required readmission and 4.3% (15) of them needed further surgical interventions, which were mainly urinary drainage procedures. Penile surgeries accounted for 34.9% of the returns. The most common reason for the ED visit was urinary tract infection in 17.2%, followed by issues related to urethral catheters and wounds (14.3% each). Univariate analysis and multivariate analysis revealed that, the directly associated variables to ED returns were patients younger than 3 yr old (OR 1.48 95%CI 1.18 to 1.87), those lived in the same city with our institution (OR 2.16 95%CI 1.69 -2.76) , procedure time > 150mins (OR 1.5 95%CI 1.12 to 2.00) and in-patient procedures (OR 1.4 95%CI 1.06 to 1.84). The Inguino-scrotal surgery types have significantly lesser ED returns (OR 0.30 95%CI 0.22 to 0.43).

Conclusions

This study shows that the majority of ED returns can be managed conservatively, and probably are preventable. This offers an opportunity for quality improvement by highlighting the importance of optimizing peri-operative family / patient education, reinforcing post-operative instructions and assures an understanding of family expectations.

Funding

none