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Updated: Jan 28, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Readmissions following ambulatory pediatric endoscopic sinus surgery
Mallory McKeon1, Genevieve Medina1, Kosuke Kawai1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
Insights
Pediatric endoscopic sinus surgery (ESS) has a 3.5% readmission rate. Very young children and those with asthma or cystic fibrosis face higher risks, warranting careful evaluation for potential inpatient admission.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Endoscopic sinus surgery (ESS) is an option for pediatric patients with persistent sinus disease.
- Ambulatory ESS aims to reduce healthcare costs and improve patient recovery.
- Understanding readmission rates and risk factors is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To analyze indications and readmission rates for pediatric ambulatory ESS.
- To identify patient subgroups at higher risk for readmission.
- To inform decisions regarding inpatient admission for specific pediatric populations undergoing ESS.
Main Methods:
- Retrospective review of the Pediatric Health Information Systems (PHIS) database (2004-2016).
- Analysis of pediatric patients (<18 years) undergoing ambulatory ESS between 2011-2016 with 30-day readmissions.
- Multivariable mixed-effects logistic regression to identify risk factors for readmission.
Main Results:
- The overall readmission rate for pediatric ambulatory ESS was 3.5% (128/3,669 cases).
- Common readmission indications included epistaxis, nausea/abdominal pain, respiratory infection, and sinusitis.
- Risk factors for readmission were younger age (<3 years), asthma, and cystic fibrosis.
Conclusions:
- Ambulatory ESS is generally safe for pediatric patients, with a low overall readmission rate.
- Younger children and those with asthma or cystic fibrosis have significantly higher readmission risks.
- Preoperative assessment should consider these risk factors to guide perioperative management and admission decisions.
Objectives/Hypothesis:
Endoscopic sinus surgery (ESS) is indicated in select pediatric patients with medically refractory sinus disease. Our objectives were to examine indications and rates of readmission following ambulatory pediatric ESS and identify specific subgroups that may benefit from inpatient admission.
Study Design:
Retrospective database review.
Methods:
The Pediatric Health Information Systems (PHIS) 2004-2016 database was retrospectively reviewed for patients age <18 years who underwent ambulatory ESS between January 2011 and December 2016 and were readmitted within 30 days postoperatively. Data regarding demographics, extent of surgery, comorbidities, adjunctive procedures, and cost were collected. A multivariable mixed-effects logistic regression model was employed for analysis.
Results:
We identified 3,669 unique pediatric ESS cases with 128 readmissions within 30 days (3.5%; 95% confidence interval [CI]: 2.9%-4.1%). Median cost of readmission was $980 (mean, $5,890; standard deviation, $13,421). The most common indication for readmission was epistaxis (17.2%), followed by nausea/abdominal pain (14.1%). Respiratory infection (13.3%) and sinusitis (10.2%) presented a combined readmission rate exceeding that of epistaxis alone. Multivariable analysis indicated age <3 years (odds ratio [OR]: 3.41, 95% CI: 1.96-5.93) and a prior diagnosis of asthma (OR: 2.88, 95% CI: 1.99-4.18) or cystic fibrosis (OR: 1.57, 95% CI: 1.00-2.44) significantly increased the risk of readmission. Extent of ESS and simultaneous adenoidectomy, septoplasty, or turbinate reduction had no significant impact on readmission rates.
Conclusions:
ESS is a relatively safe outpatient surgical procedure in pediatric patients, with an overall readmission rate of 3.5%. Clinicians should consider careful preoperative evaluation of very young patients and those with cystic fibrosis or asthma to optimize perioperative management and determine if postoperative admission is warranted, given their significantly higher readmission rates.
Level Of Evidence:
NA Laryngoscope, 129:2681-2686, 2019.
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