Preventability of Pediatric 30-Day Readmissions following Ventricular Shunt Surgery

• Published in: The Journal of pediatrics 2015-12, Vol.167 (6), p.1327-1333.e1
• Main Authors: Tejedor-Sojo, Javier, MD, Singleton, Lori M., MD, McCormick, Kelly, MSPH, Wrubel, David, MD, Chern, Joshua J., MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Equipment Failure; Female; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Male; Neurosurgical Procedures - statistics & numerical data; Patient Readmission - trends; Pediatrics; Reoperation - statistics & numerical data; Retrospective Studies; Time Factors; United States - epidemiology; Ventriculoperitoneal Shunt
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.09.017

Objective To compare the preventability of 30-day pediatric ventricular shunt readmissions using clinical and administrative data review. Study design We performed a retrospective chart review of one hundred forty-seven 30-day ventricular shunt readmissions at a tertiary pediatric center from May 2009-April 2013 under 2 scenarios: scenario 1 considered all ventricular shunt failures preventable; and scenario 2 considered shunt failures with excellent/good catheter positioning and no contributing deficiencies in care not preventable. Three physician reviewers independently assessed readmissions to determine their preventability and whether deficiencies in care existed that contributed to the readmission. We also evaluated the degree of interrater agreement in adjudicating readmission preventability. Results Only 42% of 30-day readmissions following ventricular shunt procedures were preventable when considering all shunt failures as preventable. When classifying shunts with excellent/good proximal catheter position as not preventable, 21% of ventricular shunt readmissions were deemed preventable. Interrater agreement on readmission preventability was high (kappa 0.88). Deficiencies in care existed in 29 readmissions (20%), the largest category being physician related, but not all deficiencies contributed to a readmission. Conclusions Significant discrepancy exists in the preventability adjudication of ventricular shunt readmissions between administrative and chart review. Although using administrative data has determined that a majority of readmissions following pediatric ventricular shunt procedures are preventable, our review suggests a significantly lower degree of preventability.