Jessica L. Buicko

Risk factors and costs associated with nationwide nonelective readmission after trauma

BACKGROUND Most prior studies of readmission after trauma have been limited to single institutions, whereas multi-institutional studies have been limited to single states and an inability to distinguish between elective and nonelective readmissions. The purpose of this study was to identify the risk factors and costs associated with nonelective readmission after trauma across the United States. METHODS The Nationwide Readmission Database was queried for all patients with nonelective admissions in 2013 and 2014 with a primary diagnosis of trauma. Univariate and multivariate logistic regression identified risk factors for 30-day nonelective same- and different-hospital readmission. The diagnosis groups on readmission were evaluated, and the total cost of readmissions was calculated. RESULTS There were 1,180,144 patients admitted for trauma, the 30-day readmission rate was 9.4%, and 26.4% of readmissions occurred at a different hospital. The median readmission cost for patients readmitted to the same hospital was

Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

8,298 (interquartile range,

Risk factors for nonelective 30-day readmission in pediatric assault victims

4,899–

Thirty-day readmissions following parathyroidectomy: Evidence from the National Readmissions Database, 2013–2014

14,911), whereas the median readmission cost for patients readmitted to a different hospital was

Acute Abdominal Pain Secondary to Chilaiditi Syndrome

8,568 (interquartile range,

A Structured Step-by-Step Program to Increase Scholarly Activity

4,935–

Surgical Resection of a Rare Undifferentiated Pancreatic Carcinoma with Osteoclast-Like Giant Cells: A Case Review

16,078; p < 0.01). Multivariate regression revealed that patients discharged against medical advice were at increased risk of readmission (odds ratio, 2.79; p < 0.01) and readmission to a different facility (odds ratio, 1.58; p < 0.01). Home health care was associated with a decreased risk of readmission to a different hospital (odds ratio, 0.74; p < 0.01). Septicemia and disseminated infections were the most common diagnoses on readmission (8.4%) and readmission to a different hospital (8.6%). CONCLUSIONS A significant portion of US readmissions occur at different hospitals with implications for continuity of care, quality metrics, cost, and resource allocation. Home health care reduces the likelihood of nonelective readmission to a different hospital. Infection was the most common reason for readmission, with ramifications for outcomes research and quality improvement. LEVEL OF EVIDENCE Care management/epidimeological, level IV.

Surgical Resection of a Rare Inflammatory Fibroid Polyp of the Stomach: A Case Review

The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patients recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management.

Handbook of Pediatric Surgery

PURPOSE Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. METHODS The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. RESULTS There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >7days (OR 3.028, p<0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p<0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p<0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). CONCLUSIONS Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. LEVEL OF EVIDENCE Level IV - Prognostic and Epidemiological - Retrospective Study.

Risk Factors and Costs Associated with Nationwide Non-Elective Readmissions after Thyroidectomy

PURPOSE Parathyroidectomy is one of the most common procedures performed in the United States, and are increasingly being performed safely in the outpatient setting. However, complications from surgery can be life-threatening, and thus an understanding of who may be at risk is essential. We analyzed and compared the risk factors for patients readmitted within 30 days following inpatient parathyroidectomy for primary or secondary hyperparathyroidism. MATERIALS AND METHODS We reviewed the National Readmissions Database from 2013 to 2014 for patients who received inpatient parathyroidectomy for primary or secondary hyperparathyroidism. The primary outcome was non-elective readmission within 30 days. Multivariate logistic regression was used to analyze risk factor odds ratios for readmission. RESULTS 7171 patients underwent inpatient parathyroidectomies in 2013 and 2014. 59.89% of parathyroidectomies were performed for primary hyperparathyroidism, with a 5.6% readmission rate. Most common causes of readmission were septicemia (13.69%), hypocalcemia (12.86%), heart failure (10.79%) and renal failure (9.54%). Having Medicare (OR: 1.71, CI:1.14-2.59, p = .01), Medicaid (OR: 3.24, CI: 2.03-5.17, p < .001), and self-paying (OR: 2.43, CI: 1.11-5.32, p = .02), were associated with increased odds of readmission for those with primary hyperparathyroidism. 21.99% of parathyroidectomies were performed for secondary hyperparathyroidism, with a 19.4% readmission rate. Most common causes of readmission were hypocalcemia (22.88%), hungry bone syndrome (14.38%), electrolyte disorders (13.73%), and renal failure (11.11%). CONCLUSION Patients with secondary hyperparathyroidism are older, poorer and have more comorbidities than patients with primary hyperparathyroidism, and are more likely to be readmitted within 30 days of parathyroidectomy.