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30-Day Readmission after Pediatric Upper Extremity Surgery: Analysis of the NSQIP-P Database
Stephanie Thibaudeau, MD; Jason Anari, MD; Nicholas Carducci, MD; Robert Carrigan, MD
University of Pennsylvania, Philadelphia, PA

Introduction: With increasing focus on cost reduction and quality of health care delivery, 30-day readmission rates serve as a key parameter to assess quality of patient care. There is no reference in the pediatric literature that characterizes readmission rates after upper extremity surgery. The ACS NSQIP-P (American College of Surgeons National Safety Quality Improvement Program-Pediatric) database provides a unique opportunity to confirm safety of upper extremity surgery in the pediatric population and to identify risk factors for re-admissions. The goal of this study is to determine the incidence and risk factors for complications, re-operations, and 30-day unplanned readmission after pediatric upper extremity surgery.
Methods: Retrospective analysis of the 2013 National Surgery Quality Improvement Program pediatric database to identify procedures that met the CPT code of a primary upper extremity procedure. A univariate and multivariate analysis was performed to identify patient and surgery related risk factors for complications, re-operations and 30- day unplanned readmissions.
Results: Upper extremity pediatric surgeries have low complication (1.70%), re-operation (0.5%) and re-admissions rates (0.78%). Procedures requiring re-operation, in-patient procedures, and those complicated by surgical site infection were more likely to be readmitted. In addition, multiple medical co-morbidities such as cardiac disease, gastrointestinal disease, pulmonary disease, or a central nervous system disorder were associated with readmissions. Refer to table 1-3 for patient demographics, reasons for re-admission and comparison of patient and operative characteristics requiring re-admission.
Conclusion: Pediatric upper extremity surgery is safe and associated with low complication and readmission rates. Algorithms focusing on decreasing surgical site infection and optimizing complex pediatric medical problems may further decrease complication and readmission rates.

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