Incidence of Readmission Following Pediatric Hand Surgery

An Analysis of 6600 Patients

Christopher J Goodenough, MD, MPH; Cassie A Hartline, MD; Shuyan Wei, MD; Joseph K Moffitt, BS; Alfredo Cepeda Jr; Phuong D Nguyen, MD, FACS, FAAP; Matthew R Greives, MD, MS, FACS

Disclosures

ePlasty. 2022;22(e40) 

In This Article

Abstract and Introduction

Abstract

Background: Quality in surgical outcomes is frequently assessed by the 30-day readmission rate. There are limited data available in the published literature regarding readmission rates following pediatric hand surgery. This study aims to identify factors associated with an increased risk of readmission following hand surgery in a pediatric population.

Methods: The 2012–2017 National Surgical Quality Improvement Project – Pediatric (NSQIP-P) databases were queried for pediatric patients who underwent procedures with hand-specific current procedural terminology (CPT) codes. The primary outcome was readmission.

Results: A total of 6600 pediatric patients were identified and included in the analysis. There were 45 patients who were readmitted in the study cohort, giving an overall readmission rate of 0.68%. The median time to readmission was 12 (IQR 5–20) days. On univariate analysis, factors associated with readmission included younger age, smaller size, prematurity, higher American Society of Anesthesiologists (ASA) class, inpatient admission at index operation, and longer anesthesia and operative times. Complex syndactyly repair was also associated with higher readmission rates. On multivariate analysis, ASA class 3 or 4 and inpatient surgery remained significant predictors of readmission.

Conclusions: Overall, pediatric hand surgery is associated with a very low risk of 30-day readmission. Higher ASA class and inpatient surgery increase patients' risk for readmission. In particular, complex syndactyly repair is associated with a higher risk of readmission than other hand procedures. This information is useful in surgical planning and preoperative counseling of parents.

Introduction

There has been increasing pressure on health care entities to demonstrate quality of care. The 30-day readmission rate following a surgical procedure has been identified as an important surrogate for health care quality. Consequently, understanding risks associated with readmission is relevant for patient counseling, risk stratification, and risk reduction. The Centers for Medicare & Medicaid services implemented a Hospital Readmissions Reduction Program in 2012, assigning a ratio to "standardize" unplanned readmissions and compare hospitals using this metric.[1] Whereas adult hand surgery has been associated with a low readmission rate, few studies address the risk factors for readmission in the pediatric population.[2–7]

The American College of Surgeons (ACS) National Surgical Quality Improvement Program – Pediatric (NSQIP-P) maintains a prospective database from 50 children's hospitals in the United States. These databases have been used to assess 30-day complications and readmissions in multiple disciplines within pediatric surgery.[8–14] An analysis of the NSQIP-P database is able to provide more complete data regarding readmissions following pediatric hand procedures.

This study aims to identify factors associated with an increased risk of 30-day readmission following hand surgery in the pediatric population. Our hypothesis is that pediatric hand procedures are safe procedures with low readmission rates.

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