Pediatric Surgery from the Roads Less Traveled: Challenges, Communication, and Collaboration from a Community Nonteaching Hospital.

Unique challenges face pediatric surgeons at community-based nonteaching hospitals. Communication and collaboration among and between healthcare providers, hospital administrators, and quaternary referral programs is crucial for the success of these smaller hospitals as they care for children.

Discharge practices, readmission, and serious medical complications following primary cleft lip repair in 23 U.S. children's hospitals.

BACKGROUND: Discharge timing following primary cleft lip repair balances the desire to return patients to their home environment with the risk of serious complications occurring outside a hospital. To derive information to help estimate these risks, the authors evaluated discharge practices, readmissions, and serious medical complications following primary cleft lip repair at 23 children's hospitals in the Pediatric Health Information System over a 5-year period. METHODS: The primary outcomes were discharge the same day as surgery, readmission within 48 hours, and a serious medical complication occurring during the postoperative admission. Linear mixed models were fit to assess the independent association of the covariates with each outcome variable while accounting for the correlated nature of the data within each hospital. RESULTS: Among 2558 patients undergoing primary cleft lip repair, 27.9 percent underwent same-day discharge, and 1.9 percent had an unscheduled readmission; 1.4 percent of the admitted patients had serious medical complications within 48 hours of their operation. Same-day discharge was associated with older age of the patient, absence of comorbidity, not having Medicaid, and having the surgery in a hospital with a higher annual volume of primary cleft lip repairs. Readmission was associated with Medicaid insurance and having had a surgeon with a higher primary cleft lip repair volume. Serious medical inpatient complications were associated with a preexisting patient comorbidity and a lower surgeon cleft volume. CONCLUSIONS: A number of factors related to the hospital, surgeon, patient, and patient's family bear consideration in deciding the timing of discharge after primary cleft lip repair. The most clinically important factor appears to be the overall preexisting medical status of the patient.