(127) Understanding readmissions in pediatric gynecologic surgery using a national database

Background: Readmissions within 30 days occur in 2-6% of pediatric hospitalizations or surgeries. Underlying reasons for unplanned surgical readmissions vary from patient-related factors to postoperative complications. However, most studies on pediatric surgical readmissions are limited to single-institution series or high-volume procedures. There is minimal information on information for children undergoing gynecologic surgery.

Methods: A retrospective review of pediatric gynecologic surgeries (2016 - 2022) at hospitals enrolled in the Pediatric National Surgical Quality Improvement Program (NSQIP-P) was performed. Patients who underwent gynecologic surgery followed by hospital readmission within 30 days were identified and compared to those without using standard univariate statistical analyses. Readmitted patients were then categorized based on indications. The primary outcome was the rate of 30-day readmission. Secondary outcomes were associated risk factors and indications for readmissions.

Results: Of the 4201 gynecologic surgery cases identified, 3.42% (n=144) had readmissions within 30 days of surgery. Patients readmitted were more likely to be younger (13.8 vs. 14.7 years, p-value <.001) and more likely to have baseline health comorbidities, require nutritional support (3.47% vs 0.35%, p-value <.001), or be immunosuppressed (3.47% vs 0.96%, p-value <.001; Table 1). Readmitted patients had higher American Society of Anesthesiologist (ASA) airway classifications (χ2=11.2, p-value <.001), longer operative times (100.2 vs 80.8 mins, p-value <.001), and longer total durations in the hospital after their index surgery (2.76 vs 0.19 days, p-value <.001; Table 1). The most common known indication for readmission was organ or space surgical site infection (SSI, n=8, 5.6%), followed by superficial incisional SSI (n=5, 3.5%). However “other” (n=76, 52.8%) and “unknown” (n=18, 12.5%) were overall the most common suspected reasons for readmission (Table 2). Of patients readmitted, 15.2% (n=22) required re-operation, of which 77% (n=17) were considered related to their index surgery (Table 2).

Conclusions: Overall, gynecologic surgeries among children have similar but low readmission rates compared to historical readmission rates amongst other specialties. However, there is a higher frequency of patients with comorbidities and high-risk operative considerations, including ASA classification and total operative time. A better understanding of risk factors and reasons associated with readmission can improve the quality of care in pediatric gynecologic surgery.