Do all-cause revisit rates reflect the quality of pediatric surgical care provided during index encounters?

Purpose The purpose of this study was to compare the relatedness of revisits to the index surgical encounter across different pediatric surgical procedures and to explore whether all-cause revisit rates are an accurate surrogate measure for related revisits in this cohort of children. Methods We reviewed all-cause revisits occurring within ninety days of the thirty most commonly performed pediatric surgical procedures at 44 children's hospitals between 1/1/2012 and 3/31/2015. For each condition, a team of four surgeons reviewed revisit diagnoses and reached consensus around relatedness to the index surgical encounter. Chi-squared tests were used to test for variation in all-cause and related revisits among procedures. Spearman's correlation coefficient was used to measure the association between rankings of procedures by their all-cause and related revisit rates. Results 144,535 index encounters were analyzed with an overall revisit rate of 15.0% (21,732). Significant variation was found in both the rates of all-cause revisits among procedures (ranges: 7.6–68.4%, p < 0.0001), and in the relative proportions of revisits related the index surgical encounter (range: 0% to 77%, p < 0.0001). Poor correlation was found between procedure rankings based on all-cause revisit rates and revisit rates related to the index admission (r = 0.33, p = 0.07). Conclusions The relative proportion of revisits related to the index encounter varies significantly across pediatric surgical conditions, and poor correlation exists at the procedure-level between all-cause and related revisits rates. Level of evidence IV.