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Risk Factors for 30-Day Unplanned Re-Operation in Pediatric Upper Extremity Surgery: A National Surgical Quality
Anthony K Chiu1, Theodore Quan1, Denver Kraft2
1Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Insights
The rate of unplanned re-operations after pediatric upper extremity surgery is low. Higher American Society of Anesthesiologists (ASA) class, inpatient procedures, emergent triage, and longer operative times increase re-operation risk.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Surgical Quality Improvement
Background:
- Unplanned re-operation rates are key indicators of surgical quality.
- Identifying risk factors for re-operation is crucial for improving patient outcomes in pediatric surgery.
Purpose of the Study:
- To identify independent risk factors associated with unplanned re-operations within 30 days following pediatric upper extremity surgery.
Main Methods:
- Utilized the National Surgical Quality Improvement Program-Pediatric database (2012-2019).
- Analyzed data from 27,536 pediatric patients undergoing primary upper extremity procedures.
- Employed bivariate and multivariable regression analyses to assess risk factors.
Main Results:
- A total of 290 (1.1%) patients required unplanned re-operation.
- Independent predictors for re-operation included American Society of Anesthesiologists (ASA) class III-V, inpatient procedures, emergent/urgent triage, longer operative time, and prolonged hospital stay.
Conclusions:
- The national rate of 30-day unplanned re-operations in pediatric upper extremity surgery is low.
- Key risk factors identified can aid in risk stratification and preoperative planning to enhance patient safety and outcomes.
Abstract:
Introduction The unplanned re-operation rate has been used as one marker of procedure quality in numerous surgical sub-fields. The purpose of this study was to determine independent risk factors for unplanned re-operations within 30 days following pediatric upper extremity surgery. Methods Pediatric patients who had a primary upper extremity procedure from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. The procedures included percutaneous fixation of supracondylar humerus fractures, open treatment of humeral condylar fractures, tendon sheath incision, repair of syndactyly, and reconstruction of polydactyly. Patients were categorized by those who had unplanned return to the operating room within 30 days and patients who did not. Patient demographics, clinical characteristics, and medical co-morbidities were evaluated for their association with re-operation using bivariate and multivariate analysis. Results A total of 27,536 pediatric patients underwent primary upper extremity surgeries; of these, 290 (1.1%) required an unplanned re-operation. After controlling for potential confounding variables on multivariable regression analysis, American Society of Anesthesiologists (ASA) class III-V (OR 15.89; p<0.001), inpatient procedure (OR 1.29; p=0.044), emergent/urgent triage (OR 3.75; p<0.001), longer operative time (OR 1.01; p<0.001), and prolonged hospital stay (OR 1.01; p=0.010) were independent predictors for re-operation. Conclusion This study demonstrates that the national rate of 30-day unplanned re-operation in pediatric upper extremity surgeries is low overall. The greatest risk factors for unplanned re-operation were ASA class III-V, inpatient setting, emergent/urgent triage, longer operative time, and prolonged hospital stay. This knowledge can help further improve patient outcomes through risk stratification and preoperative planning.
