Hospital Readmission Among Survivors of Pediatric Out-of-Hospital Cardiac Arrest: An Analysis of the Nationwide Readmissions Database.

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is associated with significant morbidity and mortality. Among survivors, little is known about healthcare use following discharge, including hospital readmission. We sought to describe rates for and risk factors of hospital readmission in children who survive OHCA.

Methods: Using the Nationwide Readmissions Database (2016-2019) we identified children who survived hospitalization following an OHCA and determined the rate and primary diagnoses of readmission within 30-days of discharge. We performed a univariate comparison and multivariable analysis to determine risk factors for readmission.

Results: We identified 1,671 hospitalizations eligible for 30-day readmission analysis. Of these, 13.5% (227) had a readmission within 30 days. Index OHCAs with cardiac etiology were primarily readmitted for dysrhythmias, while those with non-cardiac etiologies were primarily admitted for respiratory failure. Longer hospitalizations and patients with comorbidities had higher odds of readmission (OR: 1.01, 95%CI: 1.001, 1.011 and OR:1.51, 95%CI: 1.04, 2.19, respectively). Admission in larger cities had lower odds of readmission (OR 0.65, 95%CI: 0.43, 0.97).

Conclusion: In a nationwide cohort of children surviving to discharge following an OHCA, more than 1 in 8 children had a readmission within 30-days of discharge. Reasons for readmission differed by etiology of cardiac arrest and were more likely to occur among patients with chronic comorbidities, longer lengths of hospitalization and those admitted to small cities or rural areas. Thus, tailored anticipatory guidance and multidisciplinary follow-up practices may be important to prevent readmission.