Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.
BACKGROUND/PURPOSE
Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients.


METHODS
Unplanned 30-day readmissions following general and thoracic surgical procedures in children <18 were identified from the 2012-2014 National Surgical Quality Improvement Program- Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission.


RESULTS
Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05).


CONCLUSIONS
Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies.


LEVEL OF EVIDENCE
III.
['Polites|Stephanie F|SF|', 'Potter|Donald D|DD|', 'Glasgow|Amy E|AE|', 'Klinkner|Denise B|DB|', 'Moir|Christopher R|CR|', 'Ishitani|Michael B|MB|', 'Habermann|Elizabeth B|EB|']
D002648:Child D015331:Cohort Studies D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D010359:Patient Readmission D011183:Postoperative Complications D011184:Postoperative Period D058996:Quality Improvement D019984:Quality Indicators, Health Care D012189:Retrospective Studies D012307:Risk Factors D013514:Surgical Procedures, Operative D019616:Thoracic Surgical Procedures
Readmission Pediatric surgery Quality