Background: Unplanned surgical readmissions represent a benchmark outcome and pose a considerable cost burden for health care systems. The authors evaluated risk factors associated with readmission following pediatric plastic surgery using a prospective, validated, national database.
Methods: Patients younger than 18 years who underwent primary pediatric plastic surgery procedures were identified from the 2013 pediatric American College of Surgeons National Surgical Quality Improvement Program database.Two cohorts were compared: patients who experienced readmission and those who did not. Patient characteristics, comorbidities, intraoperative details,and 30-day postoperative outcomes, including complications and readmissions,were analyzed. Multivariate logistic regression analysis was used to identify factors associated with readmission.
Results: A total of 5376 patients were included, for an overall 2.40 percent readmission rate. The study cohort was, on average, 5.47 ± 5.21 years old,51.60 percent (n = 2774) were male, and 65.92 percent of cases (n = 3544)were outpatient procedures. The average number of relative value units per case was 10.15 ± 8.01. Patients with medical comorbidities (p < 0.001) and those with a preoperatively contaminated or infected wound were at higher risk for readmission (p < 0.001). Patients with higher American Society of Anesthesiologists scores (p < 0.001), longer operative times (p < 0.001), and longer hospitalizations (p < 0.0171) were also independently at greater risk for readmission. The most significant independent predictors of readmission were postoperative surgical and medical complications (OR, 6.94 and 11.92,respectively; p < 0.001).
Conclusion: These results help target patients at greater risk for readmission and afford an opportunity to provide evidence-based interventions to mitigate risk and minimize cost burden for health care systems. (Plast. Reconstr. Surg.135: 521, 2015.)
Clinical question/level of evidence: Risk, III.