Patient risk factors for 30-day unplanned readmission after pediatric neurosurgery: are we improving?

Thirty-day unplanned readmission is a key quality metric in pediatric neurosurgery, yet contemporary drivers of readmission in pediatric neurosurgery and whether outcomes are improving remain unknown. Thus, the authors assessed temporal readmission trends and evaluated patient- and hospital-level predictors of 30-day unplanned readmissions across major pediatric neurosurgical procedures.

A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program Pediatric data (2012-2023). Children who underwent CSF shunt placement or revision, craniosynostosis repair, tumor surgery, Chiari decompression, spine procedures, or myelomeningocele closure were included. The primary outcome was 30-day unplanned readmission; secondary endpoints were unplanned reoperation, length of hospital stay (LOS), and mortality. Multivariable logistic regression was used to identify independent predictors, including era of treatment (2012-2017 vs 2018-2023).

Among 95,104 procedures, readmissions decreased from 10.8% in 2012-2017 to 9.1% in 2018-2023 (p < 0.001), and the later era independently lowered the readmission risk (adjusted OR [aOR] 0.80, 95% CI 0.76-0.84). Unplanned reoperations decreased (from 10.4% to 9.6%, respectively, p < 0.001), LOSs shortened (from 6.89 to 5.92 days, respectively, p < 0.001), and mortality was unchanged (0.5%). Relative to those for shunt placement, readmission odds were higher after shunt revision or removal (aOR 1.28, 95% CI 1.19-1.37) and lower after craniosynostosis repair (aOR 0.26, 95% CI 0.22-0.30), Chiari decompression (aOR 0.62, 95% CI 0.56-0.69), and spine procedures (aOR 0.51, 95% CI 0.46-0.56). The readmission risk increased with a higher American Association of Anesthesiologists class (1 vs 3: aOR 1.77, 95% CI 1.48-2.12; 1 vs ≥ 4: aOR 1.76, 95% CI 1.44-2.15), nonelective case status (emergency: aOR 1.36, 95% CI 1.27-1.45), and longer anesthesia time (aOR 1.08, 95% CI 1.06-1.09). Early postoperative complications were the strongest correlates for readmission risk: organ/space surgical site infection (SSI; aOR 19.01, 95% CI 16.77-21.55) and superficial SSI (aOR 8.68, 95% CI 7.69-9.80).

Pediatric neurosurgical readmissions have improved over the past decade, but risk remains concentrated after shunt revision or removal and among nonelective, high complexity cases, highlighting targets for quality improvement and perioperative efficiency.