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Complication Timing, Failure to Rescue, and Readmission After Inpatient Pediatric Surgery.

Brian T Hickner1, Jorge I Portuondo2, Steven C Mehl3

  • 1Michael E DeBakey Department of Surgery at Baylor College of Medicine, Houston, Texas.

The Journal of Surgical Research
|August 8, 2024
PubMed
Summary
This summary is machine-generated.

Postoperative complications after pediatric surgery impact failure to rescue (FTR) and readmission differently based on timing. Pre-discharge complications are linked to FTR, while post-discharge complications increase readmission risk.

Keywords:
Complication timingFailure to rescuePediatric surgeryReadmission

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Area of Science:

  • Pediatric Surgery
  • Surgical Quality Improvement
  • Health Services Research

Background:

  • Postoperative complications are linked to mortality and readmission.
  • The timing of complications relative to discharge and its association with failure to rescue (FTR) and readmission after pediatric surgery is not well understood.

Purpose of the Study:

  • To describe the timing of complications relative to discharge after inpatient pediatric surgery.
  • To determine the association between complication timing, FTR, and unplanned readmission.

Main Methods:

  • National cohort study using the NSQIP-Pediatric database (2012-2019).
  • Complications categorized as pre-discharge, post-discharge, or both.
  • Multivariable hierarchical regression analyzed associations between complication timing and perioperative outcomes.

Main Results:

  • 8.0% of 378,551 patients experienced postoperative complications.
  • Post-discharge complications, compared to pre-discharge, showed decreased odds of FTR (OR 0.21) and increased odds of readmission (OR 19.37).
  • Complications occurring both before and after discharge had similar FTR and readmission odds to post-discharge only complications.

Conclusions:

  • Failure to rescue and readmission are associated with complications occurring at different times relative to discharge.
  • FTR is primarily linked to pre-discharge complications, while readmission is linked to post-discharge complications.
  • A 'one size fits all' approach to surgical quality improvement is likely ineffective; tailored strategies are needed.