Demographics and Risk Factors of Pediatric Pulmonary Hypertension Readmissions

Abstract

Background and objectives: Pulmonary hypertension (PH) leads to significant morbidity and mortality in pediatric patients and increases the readmission rates for hospitalizations. This study evaluates the risk factors and comorbidities associated with an increase in 30-day readmissions among pediatric PH patients.

Methods: National Readmission Database (NRD) 2017 was searched for patients less than 18 years of age who were diagnosed with PH based on the International Classification of Diseases, 10th Revision (ICD-10). Statistical Package for the Social Sciences (SPSS) software v25.0 (IBM Corp., Armonk, NY) was used for statistical analysis.

Results: Of 5.52 million pediatric encounters, 10,501 patients met the selection criteria. The 30-day readmission rate of 14.43% (p < 0.001) was higher than hospitalizations from other causes {Odds Ratio (OR) 4.02 (3.84-4.20), p < 0.001}. The comorbidities of sepsis {OR 0.75 (0.64-0.89), p < 0.02} and respiratory infections {OR 0.75 (0.67-0.85), p < 0.001} were observed to be associated with lower 30-day readmissions. Patients who required invasive mechanical ventilation via endotracheal tube {OR 1.66 (1.4-1.96), p < 0.001} or tracheostomy tube {OR 1.35 (1.15-1.6), p < 0.001} had increased unplanned readmissions. Patients with higher severity of illness based on All Patients Refined Diagnosis Related Groups (APR-DRG) were more likely to get readmitted {OR 7.66 (3.13-18.76), p < 0.001}.

Conclusion: PH was associated with increased readmission rates compared to the other pediatric diagnoses, but the readmission rate in this study was lower than one previous pediatric study. Invasive mechanical ventilation, Medicaid insurance, higher severity of illness, and female gender were associated with a higher likelihood of readmission within 30 days.

Keywords: hospital readmission rate; invasive mechanical ventilation; pediatric clinical cardiology; pediatric critical care usa; pediatric intensive care unit (picu); pulmonary hypertension; readmission rate 30 days; risk factors; severe sepsis.

Figure 1. Outcome of the index visit based on the severity of illness

The severity of illness is based on All Patients Refined Diagnosis Related Group (APR-DRG) severity of illness scoring, and the difference between the two groups was found to be statistically significant (p < 0.001).