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Same-day discharge for pediatric Nuss procedure; an analysis of the NSQIP-pediatric database from 2017-2022
John M Woodward1,2, Ali M A Khan3, Stephanie F Brierley1
1Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14215, USA.
Purpose:
Limited data exists evaluating same-day discharge for pediatric Nuss procedure; most being single-center studies. Our analysis, using the NSQIP-P registry, aimed to assess if same-day discharge for the Nuss procedure influenced post-operative outcomes.
Methods:
The NSQIP-P database (2017-2022) identified patients who underwent the Nuss procedure. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1-7 days postoperatively (non-SDD).
Results:
Of 5486 patients identified, 91 (1.7%) were SDD. From 2018 to 2022, the annual SDD rate increased from 0.8% to 2.7%. There was no significant difference between SDD and non-SDD groups for 30-day readmission (1.1% vs 3.5%, p = 0.376), reoperation (0% vs 1.5%, p = 0.643), or other outcomes. Twenty-six patients required readmission or reoperation within 3-days; only one underwent SDD. The most common readmission was for pain (n = 4) and reoperation for chest-tube placement (n = 10). Asthma (OR 1.66, 95% CI 1.03-2.67, p = 0.038), and increased operative time (per 10 min increment: OR 1.060, 95% CI 1.034-1.086, p < 0.001) each increased risk of readmission or reoperation.
Conclusion:
Same-day discharge for the Nuss procedure, although infrequent, has increased without significant differences in complications in the 91 patients who were discharged same-day in this analysis. Same-day discharge for Nuss procedure is reasonable for non-asthmatic patients with a satisfactory postoperative x-ray and meeting other goal-based discharge criteria, including adequate pain control.
Level Of Evidence (I-V):
Level III.
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