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Analysis of risk factors associated with 30-day readmissions following pediatric plastic surgery - a review of 5,376 procedures
Youssef Tahiri, MD, John P. Fischer, MD, Jason D. Wink, BA, Kaitlyn M. Paine, BM, J Thomas Paliga, BA, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Unplanned surgical readmissions represent a benchmark outcome for healthcare systems, and pose a considerable cost burden for healthcare systems. The aim of this study is to evaluate risk factors associated with readmission following pediatric plastic surgery using a prospective, validated, national database.
Patients less than 18 years old who underwent primary pediatric plastic surgery procedures were identified from the 2012 pediatric ACS-NSQIP database. Two cohorts were compared: patients who experienced readmission and those who did not. Patient characteristics, co-morbidities, intra-operative details, and 30-day post- operative outcomes including the occurrence of complications and readmissions were analyzed. A multivariate logistic regression analysis was used to identify factors associated with readmission.
A total of 5,376 patients were included in our study with an overall 2.40 % readmission rate. The study cohort was on average 5.47 ± 5.21 years of age, 51.60% (N=2,774) were male, and 65.92% of cases (n=3544) were outpatient procedures. Average number of RVUs per case was 10.15 ± 8.01. Patients with medical comorbidities (p<0.001) and those with a pre-operatively contaminated or infected wound were at higher risk for readmission (p<0.001). Additionally, patients with higher ASA scores (p<0.001), longer operative times (p<0.001) and longer hospitalizations (p<0.0171) were also independently at greater risk for readmission. The most significant independent predictors of readmission were post-operative surgical and medical complications (OR=6.94 and OR=11.92, respectively, p<0.001).
Preoperative patient-related factors and post-operative outcomes affect 30-day readmission rates in pediatric plastic surgery patients. These results help target those at greater risk for readmissions and afford an opportunity to provide evidence- based interventions to mitigate risk and minimize cost burden for healthcare systems.

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