S004: SOCIAL DETERMINANTS OF HEALTH AND THEIR EFFECT ON POST-OP READMISSION RATES
Carlos A Archilla, MD; Timothy Maul, Senior, Research, Scientist; Nemours Children's Health
Introduction: Readmissions after surgery have a negative impact on patient outcomes and healthcare costs. The financial cost ranges from $26 to $52 Billion. For pediatrics, the cost is estimated at $3.7 Billion. It also influences staffing levels and overall emotional health of our patients and families. According to the literature, the readmission rate is 14% for adults and 4 – 10% for pediatrics. Recent studies have shown that demographics and social determinants of health can influence readmission rates.
Methods: We conducted a Quality Improvement project in two self-standing pediatric hospitals (Wilmington, Delaware and Orlando, Florida) evaluating 60,458 surgeries over 20 months between 2017 and 2019. Post-surgical readmission period was defined as 30 days. All patients were assessed based on standard entry demographics like gender, age, language at home, race, and ethnicity. In addition, we asked social determinants questions which included after hours access to transportation, medical provider and prescriptions and highest level of education of caretaker. All surgical patients received a pre-operative screening call performed by an Advanced Practice Practitioner. Comparisons between groups were made using χ2, ANOVA tests as appropriate.
Results: We examined the effect of different social determinants of health on readmission rates. We also examined readmissions by surgical service and diagnosis upon readmission. The services with the highest readmission rates were urology, ENT, general surgery, and orthopedics in this order. Most common post-surgical readmission diagnoses were: fever (n=159), post-tonsillectomy bleed (n=71), dehydration (n=60), respiratory distress (n=52). In terms of readmission rate, our baseline for all surgeries was 8.3%. There was no statistical difference when comparing this rate when accounting for gender (male=8.5%, female=8.8%) or language spoken at home. There was no difference when looking at access to after hours prescriptions or medical providers or based on the highest level of education by primary caretaker. There was a higher readmission rate that was statistically significant based on 1. Race, African American=9.5% and Multiracial=11.2%. Of interest were regional differences for African American readmission rate, 6.5% for Florida and 11.1% for Delaware. 2. Ethnicity, Hispanic/Latino, 10.3% 3. Transportation, higher rate for those who lack transportation, 14.4% (regional differences were also observed with 9.7% for Florida and 25.3% for Delaware) and 4. Comorbidities (10.9% – 18.6% depending on comorbidity). When doing cross-comparisons, the rate was higher when looking at African American patients with comorbidities and this was the highest for children who have asthma and ADHD (11.5% and 24.3% respectively). All statistical values that have been presented as significant had a p value of < 0.01.
Conclusions: We conclude that our institutional readmission rate is within what was previously reported in the literature. We hypothesize that the most common postoperative readmission diagnoses could be preventable with minor interventions. We observed disparities in readmission rates among underrepresented groups and some of them even vary between different geographies. We conclude that further institutional research may be warranted to identify root causes to guide potential interventions. We conclude that the evaluation and intervention to address these disparities should be tailored to the reality of individual institutions.