Predictive factors for adverse outcomes in pediatric patients undergoing low-risk skin and soft tissue surgery: A database analysis of 6730 patients

Paediatr Anaesth. 2019 Jan;29(1):44-50. doi: 10.1111/pan.13550.


Background: There is a paucity of data regarding risk stratification of pediatric patients presenting for low-risk skin and soft tissue surgery.

Aims: We sought to determine the incidence and independent predictors of postoperative complications and unplanned 30-day readmission in a cohort of children undergoing low-risk skin and soft tissue surgery.

Methods: The study included pediatric patients who underwent minor procedures of the skin and soft tissue at continuously enrolled American College of Surgeons National Surgical Quality Improvement Program Pediatric hospitals over a two-year period. The primary outcome was a 30-day postoperative complication composite. The secondary outcome was unplanned 30-day readmission.

Results: The final analysis included 6,730 patients. There were a total of 170 postoperative complications among 152 patients (2.23%) with the majority of complications being either wound-related or postoperative mechanical ventilation. The independent predictors for an increased risk of postoperative complication were American Society of Anesthesiologists classification ≥3 and nutritional deficiency. There were 41 unplanned readmissions (0.61%). The presence of a postoperative wound complication or a postoperative pulmonary complication during the index hospital stay was an independent risk factor for unplanned 30-day readmission.

Conclusion: Pediatric patients with American Society of Anesthesiologists classification ≥3 and nutritional deficiency undergoing low-risk surgery are at risk for the development of postoperative complications. Patients who develop wound and postoperative pulmonary complications are at higher risk for unplanned 30-day readmission. Identification of these higher risk patients may allow the anesthesiologist to implement targeted therapies to minimize the likelihood of occurrence of these complications.

Keywords: ambulatory surgery; anesthesia; child; patient readmission; postoperative complications; postoperative period.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / statistics & numerical data
  • Child
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Patient Readmission
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • United States / epidemiology