Relationship between unplanned readmission and total treatment-related hospital days following management of complicated appendicitis at 31 children's hospitals

Purpose: To examine the correlation between readmission rate and total hospital days as resource utilization and quality measures for comparative analysis. Methods: Retrospective three-year audit of 8948 patients admitted with complicated appendicitis at 31 children's hospitals (6/2008-6/2011). Rates of unplanned readmission and cumulative LOS from all index and readmission encounters were analyzed for each hospital through 90 days of follow-up. The relative number and distribution of outlier hospitals identified by each measure were then compared. Results: Significant variation was found between hospitals for readmission (aggregate rate: 13.8%, range: 5.6-27.1%, chi(2) p < 0.0001) and for cumulative LOS (aggregate median: 5 days, range: 4 days [IQR: 3-6] to 7 days [IQR: 4-11], Wilcoxon p < 0.0001). Ten (32%) hospitals were identified as outliers by readmission rate and 11 (35%) by cumulative LOS. Although a similar number of outliers were identified for both measures, there was poor agreement in assigning high and low-utilization outlier status to individual hospitals (Weighted Kappa = 0.102 [95% CI:-0.167 to 0.386]). Only 2/6 (33%) low-utilizers by readmission rate were low-utilizers by cumulative LOS, and only 2/4 (50%) low-utilizers by cumulative LOS were low-utilizers by readmission rate. Conclusions: There is poor correlation between unplanned readmission and total hospital days following treatment for complicated appendicitis in children. Research and reporting for this condition should incorporate both measures to provide a more comprehensive assessment of resource utilization. (C) 2013 Elsevier Inc. All rights reserved.