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Risk Factors for Unplanned Returns to the Operating Room in Pediatric Trauma Patients

Jessica Sea1, Areg Grigorian1, Lourdes Swentek1

  • 1Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA.

The American Surgeon
|May 20, 2023
PubMed

Insights

Unplanned returns to the operating room (uROR) occurred in less than 1% of pediatric trauma patients but were linked to higher mortality and complications. Key predictors included rectal, brain, and gunshot wound injuries.

Area of Science:

  • Trauma Surgery
  • Pediatric Surgery
  • Surgical Outcomes

Background:

  • Unplanned returns to the operating room (uROR) are associated with adverse outcomes in adult surgical patients.
  • The incidence and predictors of uROR in pediatric trauma patients (PTPs) remain largely uncharacterized.
  • Understanding uROR in PTPs is crucial for improving patient safety and care quality.

Purpose of the Study:

  • To determine the incidence of uROR in pediatric trauma patients (PTPs).
  • To identify independent predictors associated with uROR in PTPs.
  • To compare outcomes between PTPs with and without uROR.

Main Methods:

  • Utilized the 2017-2019 Trauma Quality Improvement Program (TQIP) database.
  • Included pediatric trauma patients aged 1 to 16 years.
  • Performed multivariable logistic regression to identify risk factors for uROR.

Main Results:

  • The incidence of uROR was 0.7% (299 out of 44,711 PTPs).
  • Patients with uROR were older and experienced significantly higher mortality rates (8.7% vs. 1.4%), increased complications (surgical infection, compartment syndrome), and longer lengths of stay (LOS).
  • Independent predictors for uROR included rectal injury (OR 4.54), brain injury (OR 3.68), and gunshot wounds (OR 2.55).

Conclusions:

  • The incidence of uROR in PTPs is low (<1%) but associated with significantly worse outcomes, including increased mortality and LOS.
  • Rectal injury, brain injury, and gunshot wounds are significant predictors of uROR in PTPs.
  • Targeted interventions and counseling for PTPs with these risk factors are warranted to mitigate uROR risk and improve care.
Abstract

Keywords:
pediatrictraumaunplanned return to operating room

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