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Safety of same-day discharge following vagus nerve stimulator insertion in children: a National Surgical Quality
Jillian DiBiase1, Keith J Kilner1, Eric C Cheon1
11Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago.
Insights
Same-day discharge after vagus nerve stimulator (VNS) insertion in children with epilepsy is safe. This study found no increased risk of readmission for pediatric patients discharged on the same day versus those admitted overnight.
Area of Science:
- Pediatric Surgery
- Neurology
- Health Services Research
Background:
- Vagus nerve stimulator (VNS) insertion is a common treatment for pediatric drug-resistant epilepsy.
- Optimizing postoperative care for pediatric VNS procedures is crucial due to the increasing number of patients undergoing surgery.
Purpose of the Study:
- To evaluate readmission and reoperation rates following VNS insertion in children.
- To determine if same-day discharge impacts postoperative outcomes compared to inpatient admission.
Main Methods:
- Retrospective analysis of the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2022).
- Inclusion of 3070 pediatric patients undergoing VNS insertion (CPT code 64568).
- Primary outcome: unplanned readmission within 7 days; analysis using propensity score matching and multivariable logistic regression.
Main Results:
- A total of 3070 pediatric patients were analyzed, with 2.1% experiencing unplanned readmission within 7 days.
- No statistically significant differences in baseline characteristics were observed between same-day discharge and inpatient admission cohorts.
- Same-day discharge was not associated with a higher rate of unplanned readmissions compared to inpatient admission (OR 1.19, p=0.5).
Conclusions:
- Same-day discharge for pediatric vagus nerve stimulator insertion is a safe option.
- Discharge timing (same-day vs. inpatient) does not significantly affect 7-day readmission rates in pediatric epilepsy patients receiving VNS.
Objective:
Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aimed at optimizing postoperative care protocols. The objective of this retrospective study was to characterize the readmission and reoperation rates associated with VNS insertion in children.
Methods:
The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2012 to 2022 to find patients who underwent VNS insertion (CPT code 64568). The primary outcome measured was unplanned readmission within 7 days of VNS insertion. Propensity score matching on the criteria of baseline demographics was applied. Multivariable logistic regression analysis was conducted to determine if age, race, or anesthesia time affected same-day discharge as well as unplanned readmission and reoperation rates.
Results:
A total of 4267 patients who underwent VNS insertion were identified in the NSQIP-P database from 2012 to 2022. After excluding patients with missing data and readmissions > 7 postoperative days, 3070 patients were included in the final analysis. Of those patients, 63 (2.1%) experienced an unplanned readmission within 7 days of their procedure. Propensity score matching differentiating between those with a total hospital length of stay of 0 days (same-day discharge) and > 0 days (inpatient admission) on the criteria of age (p = 0.63), sex (p = 0.77), race (p = 0.99), Hispanic ethnicity (p = 0.84), and American Society of Anesthesiologists classification (p = 0.18) showed no statistically significant difference in baseline characteristics between the two cohorts. No significant difference in unplanned readmissions was found between patients with same-day discharge versus those with inpatient admission (OR 1.19, 95% CI 0.72-1.99; p = 0.5).
Conclusions:
Same-day discharge of pediatric patients undergoing VNS insertion was not associated with higher readmission rates compared to patients who stayed in the hospital for more than 1 day.
