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Postoperative Disposition Following Pediatric Sistrunk Procedures: A National Database Query
Jennifer A Brooks1, Michael J Cunningham1, Amy L Hughes2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.
Insights
Ambulatory management after a Sistrunk procedure is safe for children. This approach does not increase complications or readmissions, suggesting it can be a viable option for select cases.
Area of Science:
- Pediatric surgery
- Surgical outcomes
- Postoperative care
Background:
- Sistrunk procedures are performed for pediatric neck masses.
- Postoperative management varies, with options including discharge home or overnight observation.
- Overnight observation is presumed to reduce complications and readmissions.
Purpose of the Study:
- To investigate the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures.
- To analyze postoperative complication and revisit rates based on disposition.
- To clarify best practices for postoperative care following pediatric Sistrunk procedures.
Main Methods:
- Retrospective database review.
- Utilized the Pediatric Health Information System (PHIS) database.
- Included 6,434 patients from 2007 to 2016, categorized into ambulatory and overnight observation cohorts.
Main Results:
- The overall 30-day revisit rate was 4.9%.
- Ambulatory patients had a lower revisit rate (3.8%) compared to overnight observation (6.1%).
- Younger children (≤2 years) had higher revisit rates; common indications included fluid collection and neck swelling.
Conclusions:
- Ambulatory management following a Sistrunk procedure is not associated with increased postoperative complications, readmission, or need for secondary surgery.
- A Sistrunk procedure can be safely performed on an ambulatory basis in select pediatric patients.
- This finding supports the potential for outpatient management in appropriate cases.
Objective/Hypothesis:
Variability exists in the postoperative disposition of children following Sistrunk procedures. Management options include discharge home versus overnight observation, with the latter allowing monitoring for immediate postoperative complications, presumably reducing the need for subsequent readmission. This study investigates the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures and relevant postoperative complication and revisit rates to clarify best practice for these patients.
Methods:
This was a retrospective database review using the Pediatric Health Information System database from 2007 to 2016.
Results:
The cited dataset identified 6,434 qualifying patients, categorized into ambulatory versus overnight observation cohorts. The overall 30-day revisit rate was 4.9%; the revisit rate with overnight observation (6.1%) was higher than for ambulatory patients (3.8%, adjusted odds ratio (OR) 1.60; 95% confidence interval (CI): 1.21, 2.12). Revisit rates were significantly higher in patients 2 years of age or younger compared to older patients (6.7% vs. 4.3%). The rates of return to the operating room for the observation versus ambulatory groups were 1.8% and 0.5%, respectively. Cervical fluid collection and neck swelling were among the most common revisit indications in both groups, with a mean time to presentation of 9 days.
Conclusions:
This study demonstrates that ambulatory management following a Sistrunk procedure is not associated with increased rates of common postoperative complications, readmission, or need for secondary surgical intervention. A Sistrunk procedure may be safely performed on an ambulatory basis in select cases.
Level Of Evidence:
IV Laryngoscope, 131:E2352-E2355, 2021.
