Pediatric Surgery

A group of researchers at the University of California, Davis Medical Center, identified pediatric surgery with the highest rate of unplanned hospital readmission up to 30 days post-surgery. They also identified sociodemographic and medical risk factors associated with readmission.

 

In a recent study published in JAMA Surgery, researchers identified surgical procedures and patient factors associated with hospital readmission rates in the 30 days following pediatric surgery. They used previously collected data from the American College of Surgeons Pediatric National Surgery Quality Improvement Program. This data tracks surgical procedures performed, 30-day outcomes, and preoperative and intraoperative risk factors that could account for hospital readmissions. Data recorded from 2012 to 2014 including 183,233 children younger than 18 years at 56 children’s hospitals in the United States were analyzed in the study.

Of the 183,233 patients, 8,838 (4.8%) were readmitted to the hospital within 30 days of their initial pediatric surgeries.Of these patients, 712 (8.1%) had more than one readmission within 30 days. The majority of readmissions were unplanned, and almost half were not related to the patient’s initial operations.

The researchers identified pediatric surgeries with the highest 30-day unplanned readmission rates. The three surgeries with the highest rates were laparoscopic ileostomy/jejunostomy, portoenterostomy, and diagnostic thoracoscopy. The first two surgeries involve the small bowel, while the latter refers to a procedure used to diagnose pulmonary disease. When readmissions were examined by medical specialty, children who received neurosurgical procedures were the most likely to be readmitted.

The reasons for related (related to the surgeries performed) and unrelated readmissions (unrelated to the surgeries performed) were also examined. Infection at the surgical site was the most common reason for related readmissions, while seizures, pneumonia, and urinary tract infections were the most common causes of unrelated readmissions. Risk factors for 30-day unplanned readmissions included the following: neurosurgical or laparoscopic procedures, female sex, Asian race/ethnicity, higher American Society of Anesthesiologists classification (higher level indicates worse health prior to surgery), current cancer treatment, patients with cerebral palsy, and patients with clean-contaminated cases (surgical site contains some microbial contaminants). Conversely, neonatal patients who underwent urologic procedures versus pediatric general surgery were less likely to experience unplanned readmissions.

An understanding of risk factors associated with unplanned readmissions to the hospital following pediatric surgery is needed to better serve patients and improve quality of care, although not all risk factors are modifiable. While this study was strengthened by a large sample size, it included data from only 56 children’s hospitals, which may not be representative of all surgical centers nationally.

Written by Suzanne M. Robertson, Ph.D

Reference:

Anderson, Jamie E., et al. “Association of Procedures and Patient Factors With 30-Day Readmission Rates After Pediatric Surgery.” JAMA surgery(2017).

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