Comparison of 30-Day Bounce-backs after Pediatric versus Adult Urologic Surgery
Courtney L. Shepard, M.D., Julian H.C. Wan, M.D..
University of Michigan, Ann Arbor, MI, USA.
More pediatric patients seem to present to the emergency room for non-urgent matters after urologic procedures compared to adult patients. We compare our 30 day post-operative bounce-back rates and the acuity of the concerns in these populations.
All urology consults at our institution are maintained on a prospectively tracked database. We identified all patients who presented to our adult or pediatric emergency department between July 2013 and June 2015 within 30 days of a urologic procedure. We investigated the procedures performed, chief complaint in the ED, diagnosis, and treatment required.
In our pediatric group, there were 67 visits in 56 patients (19 female, 37 male, mean age 7.4 years), which represents an incidence of 2.5%. Of those, 19% required admission, 10% underwent a procedure, 18% required catheter manipulation/placement, 13% were given a prescription (most commonly for constipation), 6% required local wound care, and 33% were reassured only.
In the adult population, there were 369 visits in 310 patients (111 female, 199 male, mean age 55.4 years) for an incidence of 3.5%. Of those, 42% were admitted, 14% underwent a procedure, 11% required catheter manipulation/placement, 14% were given medication (most commonly antibiotics and narcotics), 4% were given local wound care, and 12% were reassured.
Compared to adults, pediatric patients are less likely to return to the ED post-operatively (p=0.03), but they are significantly more likely to require only reassurance (p<0.01) while adults are significantly more likely to require hospital admission or a procedure (p<0.01). In both groups, nearly one third of patients required only catheter care or medication. Better anticipation of post-operative medication needs and catheter education could decrease unnecessary ED visits and health care costs.
|Admission or Procedure||Medical Treatment or Catheter Manipulation/Placement||Reassurance Only (No treatment)|
|All Pediatric Patients||29%||38%||33%|
|All Adult Patients||56%||32%||12%|
|P value||p < 0.01||p = 0.49||p < 0.01|
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