Identifying Risk Factors for Emergency Department Return and Readmission After Pediatric Orthopaedic Surgery: A
Devika A Shenoy1, Christian F Zirbes, Aaron D Therien
1From the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
Insights
Unplanned returns to the emergency department (RTED) and hospital readmissions after pediatric surgery are linked to Medicaid insurance and specific procedures like infection, spine deformity, or soft tissue reconstruction. Enhanced postoperative support is crucial for high-risk patients.
Area of Science:
- Pediatric Orthopaedic Surgery
- Healthcare Outcomes Research
- Health Services Research
Background:
- Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery represent significant healthcare burdens.
- These events may indicate gaps in patient care quality and postoperative management.
- Identifying risk factors is crucial for improving patient outcomes and optimizing resource allocation.
Purpose of the Study:
- To identify risk factors associated with RTED and unplanned readmissions following pediatric orthopaedic surgery.
- To analyze the impact of patient demographics, insurance status, and surgical procedure type on postoperative outcomes.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) undergoing orthopaedic surgery (2017-2023).
- Data included demographics, insurance, BMI, language, and procedure complexity (work relative value units).
- Logistic regression analyses identified predictors for RTED and readmission at 7, 30, and 90 days.
Main Results:
- Medicaid insurance was associated with increased odds of 30-day and 90-day RTED and 90-day readmission.
- Hispanic ethnicity linked to 90-day RTED; Black or African American race linked to 7-day and 30-day readmission.
- Infection and soft tissue reconstruction surgeries associated with 7-day RTED; spine deformity surgery associated with 30-day and 90-day readmission.
Conclusions:
- Medicaid insurance status and specific procedures (infection, spine deformity, soft tissue reconstruction) identify high-risk pediatric surgical patients.
- Findings highlight the need for targeted postoperative support programs to reduce adverse events.
- Proactive interventions can mitigate risks and improve outcomes for vulnerable pediatric surgical populations.
Background:
Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery are notable burdens on the healthcare system and markers of potential gaps in patient care. The objective of this study was to identify the risk factors associated with RTED and unplanned readmissions after pediatric orthopaedic surgery.
Methods:
A retrospective cohort study was conducted between 2017 and 2023 and included patients younger than 18 who underwent orthopaedic surgery at a single, large academic institution. Patient data included current procedural terminology code, demographics, body mass index, insurance, language, and case complexity proxied by work relative value units. Procedural categories were defined by Accreditation Council for Graduate Medical Education case log guidelines for pediatric orthopaedics using current procedural terminology codes. The primary outcomes were RTED and hospital readmission within 7, 30, and 90 days of the index procedure. Univariable and multivariable logistic regression analyses were done to identify notable predictors for each outcome.
Results:
In total, 3,044 pediatric patients were included. In multivariable analysis, patients with Medicaid insurance had a higher odd of RTED at 30 days (odds ratio [OR] 2.26, P = 0.007) and 90 days (OR 2.39, P < 0.001), and a higher odd of readmission at 90 days (OR 3.82, P = 0.002). Hispanic ethnicity was associated with 90-day RTED (OR 1.54, P = 0.023). Black or African American race was associated with 7-day (OR 9.24, P = 0.012) and 30-day (OR 4.00, P = 0.013) readmission. After controlling for demographic variables, operations for infection (OR 15.3, P = 0.002) and soft tissue reconstruction (OR 5.45, P = 0.046) were associated with 7-day RTED. Spine deformity surgery was associated with 30-day (OR 12.0, P = 0.006) and 90-day (OR 5.19, P = 0.031) readmission.
Conclusion:
Medicaid insurance status and the type of surgical procedure (infection, spine deformity, or soft tissue reconstruction) may represent high-risk populations for postoperative RTED and readmission. These findings underscore the need for enhanced postoperative patient support programs to mitigate adverse outcomes.
