P2.002: Sociodemographic and Clinical Factors Associated With Unplanned Readmissions in Children With Congenital Heart Disease.

Background: Limited research has investigated the contributions of specific social and clinical factors to unplanned readmissions for children with congenital heart disease (CHD). This study aimed to evaluate associations between sociodemographic and clinical factors and the number of unplanned readmissions within 0-30 days, 30-90 days, and up to 3 years post-discharge for children with CHD.

Methods: Inclusion criteria were patients aged 0-2 years with CHD admitted for their first hospitalization of their life to the cardiac inpatient units at a children’s hospital medical center in the USA between 1/1/2021 and 2/10/2021. Automatic data extraction from the electronic health record and manual chart reviews were conducted. Data on unplanned readmissions were collected through 12/31/2024. Childhood Opportunity Index (COI) was analyzed in quintiles (Table 1). For each admission, clinical scoring tools (e.g., Functional Status Score [FSS] and Pediatric Cerebral Performance Category [PCPC]) were calculated, and status at discharge was recorded (Table 1). Univariate linear regression assessed relationships between sociodemographic and clinical variables and unplanned readmissions. Log transformations were performed for variables that were not normally distributed.

Results: During the study period, 28 consecutively admitted patients met inclusion criteria, of which, 14 (50.0%) experienced subsequent unplanned readmission to the hospital. Patients with a COI level in the lowest quintile had 4.5 times (IQR: 1.3,16.0) more unplanned readmissions on average compared to those from the highest COI quintile (p=0.020). Patients with non-English-speaking guardians had 8.1 times (IQR: 2.0,33.0) more unplanned readmissions compared to those with English-speaking guardians (p=0.005). Within 30-90 days post-discharge, patients of non-Hispanic ethnicity had 27% (IQR: 7%,42%; p = 0.012) fewer readmissions while those with private insurance had 22% fewer readmissions (IQR: 2%,39%; p = 0.035). Patients with a Pediatric Cerebral Performance Category of 2 had 2.5 times (IQR: 1.1,5.6) higher readmission rates compared to those with a category of 1 (p=0.026). For every one unit increase in Functional Status Score, total readmissions increased by 20% (IQR: 1.1,1.3; p=0.003). Patients who were not initially discharged with home oxygen had 46% fewer (IQR: 7%,69%) readmissions on average compared to those who were (p=0.029). Patients with a CHD diagnosis class of 4 had 2.9 times (1.1,7.6) more readmissions on average compared to those with a CHD diagnosis class of 1 (p=0.029). Finally, patients who did not require ECMO had 88% (IQR: 50%, 97%) fewer readmissions compared to those who did (p=0.005).

Conclusion: Rates of unplanned readmissions were significantly higher among CHD patients with sociodemographic adversity and/or higher medical acuity. These results underscore the influence of sociodemographic factors on unplanned admission risk. Data collection for this study is ongoing and will include evaluating the interactions between sociodemographic and clinical variables with a larger sample size, including impact on health outcomes upon subsequent unplanned readmissions.