PRS AAPS Oral Proofs 2016
Wen Xu, BS, Patrick A. Gerety, MD, Jing Li, MD, Justin P. Fox, MD, Ari M. Wes, BA, Scott Bartlett, MD, Jesse A. Taylor, MD
From the Children’s Hospital of Philadelphia, Philadelphia, Pa.
PURPOSE: The purpose of this study is to identify risk factors for hospital-based acute care (HBAC) in the perioperative period in craniosynostosis patients.
METHODS: By using 4 state-level databases, we conducted a retrospective cohort study of patients younger than 3 years who underwent surgery for craniosynostosis. The primary outcome was the use of HBAC (emergency department visit or hospital readmission) within 30 days of discharge. Multivariate logistic regression modeling was used to identify patient-level factors associated with the outcome.
RESULTS: The final sample included 1120 patients. Patients were an average of 4.6 months old; 68.1% were male, 42% white, 25% Hispanic, and 6% African American. Ninety-nine patients (8.8%) had at least 1 HBAC encounter within 30 days. The most frequent indications for HBAC were surgical site infection, fever, or nausea/vomiting, and most encounters occurred in the emergency department without inpatient admission (59.3%). Average charge per encounter was $16,752. In univariate analysis, older age, race, insurance status, and longer initial hospitalization were significantly associated with HBAC. In multivariate analysis, only African American race [AOR = 5.98 (1.49–23.94)] and Hispanic ethnicity [AOR = 5.31 (1.88–14.97)] was associated with more frequent HBAC encounters.
CONCLUSIONS: These data reveal that HBAC occurs in approximately 10% of craniosynostosis patients perioperatively and that race and socioeconomic status are independent risk factors. Developing strategies to mitigate these disparities will be the focus of future research.