Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis

Kulaylat, Afif N.; Rocourt, Dorothy V.; Tsai, Anthony; Martin, Katherine L.; Engbrecht, Brett W.; Santos, Mary C.; Cilley, Robert E.; Hollenbeak, Christopher S.; Dillon, Peter W.

doi:10.1016/j.jpedsurg.2017.07.021

Cited by 33 publications

(33 citation statements)

References 40 publications

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“…Univariable analysis showed ASA classification and specific comorbidities were significant contributors to readmission (Table S4). This finding is similar to a prior study, which found that ASA classification and patient comorbidity such as cardiac, pulmonary, and nutritional deficiency imparted increased adjusted readmission risk, suggesting that baseline patient characteristics predispose to readmission, regardless of procedure type . Further supporting this idea is the fact that 48.8% of our readmissions was unrelated to the principal operation (Tables S5 and S6).…”

Section: Discussionsupporting

confidence: 90%

“…Further supporting this idea is the fact that 48.8% of our readmissions was unrelated to the principal operation (Tables S5 and S6). However, upon multivariable analysis, we found that patients with a postoperative complication during their index surgical admission were ultimately at a greater risk for readmission, also echoing prior studies . Of those patients readmitted for wound complications, 70.59% had a postoperative wound complication during their original admission.…”

Section: Discussionsupporting

confidence: 80%

“…This finding is similar to a prior study, which found that ASA classification and patient comorbidity such as cardiac, pulmonary, and nutritional deficiency imparted increased adjusted readmission risk, suggesting that baseline patient characteristics predispose to readmission, regardless of procedure type. 25 Further supporting this idea is the fact that 48.8% of our readmissions was unrelated to the principal operation (Tables S5 and S6). However, upon multivariable analysis, we found that patients with a postoperative complication during their index surgical admission were ultimately at a greater risk for readmission, also echoing prior studies.…”

Section: Thirty-day Readmissionsmentioning

confidence: 63%

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

Cheon

Longhini

Lee

et al. 2018

Pediatric Anesthesia

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Summary 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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 80%

Section: Thirty-day Readmissionsmentioning

confidence: 63%

See 1 more Smart Citation

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

Cheon

Longhini

Lee

et al. 2018

Pediatric Anesthesia

View full text Add to dashboard Cite

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“…Postoperative opioid‐related decreased bowel motility or ileus is well documented in the adult population and is importantly associated with readmission in children . Treatment and incidence of opioid‐induced ileus has only minimally been explored in the literature in infants and children . Contrary to adult studies, methylnaltrexone appears to be helpful in children …”

Section: Opioid Side Effects In Childrenmentioning

confidence: 99%

“…Treatment and incidence of opioid‐induced ileus has only minimally been explored in the literature in infants and children . Contrary to adult studies, methylnaltrexone appears to be helpful in children …”

Section: Opioid Side Effects In Childrenmentioning

confidence: 99%

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Cravero

Agarwal

Berde

et al. 2019

Pediatric Anesthesia

124

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SummaryOpioids have long held a prominent role in the management of perioperative pain in adults and children. Published reports concerning the appropriate, and inappropriate, use of these medications in pediatric patients have appeared in various publications over the last 50 years. For this document, the Society for Pediatric Anesthesia appointed a taskforce to evaluate the available literature and formulate recommendations with respect to the most salient aspects of perioperative opioid administration in children. The recommendations are graded based on the strength of the available evidence, with consensus of the experts applied for those issues where evidence is not available. The goal of the recommendations was to address the most important issues concerning opioid administration to children after surgery, including appropriate assessment of pain, monitoring of patients on opioid therapy, opioid dosing considerations, side effects of opioid treatment, strategies for opioid delivery, and assessment of analgesic efficacy. Regular updates are planned with a re‐release of guidelines every 2 years.

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Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

Nayak

Allori

et al. 2022

JAMA Surg

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ImportanceUse of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized.ObjectiveTo evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery.Design, Setting, and ParticipantsThis is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons’ Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (&lt;18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery.ExposuresContinuation of antimicrobial prophylaxis beyond time of incision closure.Main Outcomes and MeasuresThirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures.ResultsForty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = −0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85).Conclusions and RelevanceUse of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.

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Understanding readmissions in children undergoing surgery: A pediatric NSQIP analysis

Cited by 33 publications

References 40 publications

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

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

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

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