Risk Factors and Causes of Readmission to the Pediatric Intensive Care Unit After Cardiac Surgery

IntroductionUnplanned readmissions to the pediatric intensive care unit (PICU) following cardiac surgery remain poorly understood. Such readmissions are associated with increased morbidity and present significant challenges to healthcare. This study aimed to identify characteristics associated with unplanned PICU readmission during the same hospitalization following cardiac surgery.MethodWe conducted a retrospective analysis using prospectively collected data from a tertiary care children's hospital from January 2015 to January 2021. All pediatric patients who underwent cardiac surgery and were transferred alive from the PICU were included. Each patient readmitted to the PICU was matched to two controls based on age and PELOD score at the time of initial PICU admission postsurgery to identify factors associated with readmission among 72 variables.ResultsOf the 956 patients discharged alive from the PICU after cardiac surgery, 23 (2.4%) required unplanned readmission. Over half (12/23, 52.2%) of these readmissions occurred within 48 h of PICU discharge. Univariate analysis identified preoperative arrhythmias (P = .037) and postoperative single-ventricle physiology (P = .024) as potential risk factors for readmission. Male sex appeared to be a protective factor against unplanned PICU readmission (P = .026). Although preoperative vasopressor requirement, postoperative altered ventricular function and known pleural effusion at PICU discharge were not significantly associated with PICU readmission, these factors showed a trend toward significance. After multivariate analysis, postoperative single-ventricle physiology remained the sole independent risk factor associated with unplanned PICU readmission with an odds ratio of 8.6 (95% confidence interval, 1.9-46.5).ConclusionWhile unscheduled PICU readmissions following cardiac surgery are rare, postoperative single-ventricle physiology emerged as an independent risk factor.