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OBJECTIVE Compare emergency general surgery (EGS) patient outcomes following index and non-index hospital readmissions, and explore predictive factors for non-index readmission. BACKGROUND Readmission to a different hospital leads to fragmentation of care. The impact of non-index readmsision on patient outcomes following EGS is not well established. METHODS The Nationwide Readmissions Database (2017) was queried for adult patients readmitted following an EGS procedure. Patients were stratified and propensity-matched according to readmission destination: index vs. non-index hospital. Outcomes were failure to rescue (FTR), mortality, number of subsequent readmissions, overall hospital LOS, and total costs. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors. RESULTS A total of 471,570 EGS patients were identified, of which 79,127 (16.8%) were readmitted within 30 days: index hospital (61,472; 77.7%) vs. non-index hospital (17,655; 22.3%). Following 1:1 propensity matching, patients with non-index readmission had higher rates of FTR (5.6% vs. 4.3%; p < 0.001), mortality (2.7% vs. 2.1%; p < 0.001), and overall hospital costs (in $1000; 37 [27-64] vs. 28 [21-48]; p < 0.001). Non-index readmission was independently associated with higher odds of FTR (aOR 1.18 [1.03-1.36]; p < 0.001). Predictors of non-index readmission included top quartile for zip code median household income (1.35 [1.08-1.69]; p < 0.001), fringe county residence (1.08 [1.01-1.16]; p = 0.049), discharge to a skilled nursing facility (1.28 [1.20-1.36]; p < 0.001), and leaving AMA (2.32 [1.81-2.98]; p < 0.001). CONCLUSION One in five readmissions after EGS occur at a different hospital. Non-index readmission carries a heightened risk of FTR. LEVEL OF EVIDENCE Level III Prognostic STUDY TYPE:: Prognostic.

OBJECTIVE To evaluate racial disparities among White and Black pediatric firearm injury patients on a national level. BACKGROUND Pediatric firearm-related morbidity and mortality are rising in the United States. There is a paucity of data examining racial disparities in those patients. METHODS The Pediatric Trauma Quality Improvement Program (2017) was queried for pediatric (age ≤17 years) patients admitted with firearm injuries. Patients were stratified by race: White and Black. Injury characteristics were assessed. Outcomes were mortality, hospital length of stay, and discharge disposition. Hierarchical regression models were performed to determine predictors of mortality and longer hospital stays. RESULTS A total of 3717 pediatric firearm injury patients were identified: Blacks (67.0%) and Whites (33.0%). The majority of patients were male (84.2%). The most common injury intent in both groups was assault (77.3% in Blacks vs in 45.4% Whites; P