Assessing Risk Factors for Hospital-Based Acute Care within 30 Days of Craniosynostosis Surgery using the Healthcare Cost and Utilization Project (HCUP)
Patrick A. Gerety, MD, Wen Xu, BS, Jing Li, MD, Justin P. Fox, MD, Ari M. Wes, BA, Scott Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: The purpose of this study is to identify risk factors for hospital-based, acute care (HBAC) in the peri-operative period in craniosynostosis patients.
METHODS: Using four state-level databases, we conducted a retrospective cohort study of patients less than 3 years of age who underwent surgery for craniosynostosis. The primary outcome was the use of hospital-based, acute care (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 1,120 patients. Patients were an average of 4.6 months old; 68.1% were male, 42% Caucasian, 25% Hispanic, and 6% African-American. Ninety-nine patients (8.8%) had at least one 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 \,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.
CONCLUSION: These data reveal that HBAC occurs in nearly 10% of craniosynostosis patients peri-operatively and that race and socioeconomic status are independent risk factors. Developing strategies to mitigate these disparities will be the focus of future research.
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