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Comparison of Outpatient and Inpatient Pediatric Rhinoplasty: Results From National Surgical Quality Improvement
Ravi K Garg1, Catharine B Garland1, Delora L Mount1
1Division of Plastic and Reconstructive Surgery.
Insights
Pediatric rhinoplasty patients are often managed as inpatients, even when outpatient care is safe and cost-effective. This study found no increased complication risk for outpatients, suggesting more ambulatory management is possible.
Area of Science:
- Pediatric Surgery
- Health Services Research
Background:
- Outpatient management of elective surgeries reduces healthcare costs compared to inpatient care.
- Current practices in pediatric rhinoplasty management (inpatient vs. outpatient) require investigation.
Purpose of the Study:
- To investigate current practices in outpatient versus inpatient management of pediatric rhinoplasty patients.
- To compare clinical characteristics and complications between inpatient and outpatient pediatric rhinoplasty.
Main Methods:
- Analysis of the 2012-2014 National Surgical Quality Improvement Program-Pediatric data sets.
- Inclusion of pediatric patients (age ≤17) undergoing primary rhinoplasty.
- Comparison of inpatient vs. outpatient management using univariate and multivariate logistic regression.
Main Results:
- 21.2% of 938 pediatric rhinoplasty patients were inpatients.
- Inpatient management was associated with younger age, congenital malformations, longer procedure times, and specific surgical approaches.
- Complications were rare (1.6% readmission), with no significant difference between inpatient and outpatient groups.
Conclusions:
- Pediatric rhinoplasty patients, particularly certain subgroups, have an increased likelihood of inpatient management without a higher risk of complications.
- Selecting appropriate pediatric patients for ambulatory rhinoplasty could improve cost-effectiveness and quality of care.
Introduction:
Outpatient management of patients undergoing elective surgical procedures has been associated with significantly decreased health care costs compared with inpatient management. This study investigates current practices in outpatient versus inpatient management of pediatric rhinoplasty patients.
Methods:
A query was performed of the 2012 to 2014 National Surgical Quality Improvement Program-Pediatric data sets. Patients age 17 or younger undergoing rhinoplasty as the primary surgical procedure were included. Clinical characteristics and complications were compared among patients managed as inpatients versus outpatients using both univariate and multivariate logistic regression analyses.
Results:
Among 938 pediatric rhinoplasty patients, 199 (21.2%) were managed as inpatients. Multivariate analysis revealed multiple variables significantly associated with an increased odds of inpatient management, including young patient age, presence of a congenital malformation, neurologic or nutritional disease, lengthy procedure time, management by a plastic surgeon compared with an otolaryngologist, and certain procedure types including cleft septorhinoplasty, secondary rhinoplasty with intermediate or major revision, and rib cartilage grafting. Complications among both inpatients and outpatients were rare, with the most common complication being readmission among 15 patients (1.6%).
Conclusions:
This study indicates that multiple subgroups of pediatric patients undergoing rhinoplasty procedures have a significantly increased likelihood of inpatient management without any significantly increased likelihood of a complication or need for readmission. Future efforts to manage appropriately selected children on an ambulatory basis may be safe, while improving costs and quality of care.
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