Canadian journal of anaesthesia = Journal canadien d’anesthesie 2017 04 21() doi 10.1007/s12630-017-0888-y
The majority of pediatric surgeries are performed in a day surgery setting. The rate of adverse postoperative outcomes and the factors that influence them are poorly described in the Canadian setting. Concerns about the safety of adenotonsillectomy (AT) have been raised. The objective of this Ontario-based study was to determine the rates and risks of hospital readmission, emergency department (ED) visits, or deaths within 30 days following common pediatric surgeries, with an emphasis on AT.
Inpatient and day surgery children who were < 18 yr of age and undergoing one of the ten most common surgeries in Ontario from 2002-2013 were identified by linking four provincial health administrative databases. Risk of each outcome was determined separately for all surgeries. Cox regression was used to measure the association of demographics, clinical factors, Ontario drug benefit (ODB) status, and prescribed opioids with adverse outcomes. RESULTS
Among 364,629 children, AT accounted for 30.5% of all surgeries. The AT patient rates of readmission and ED visits compared with the full study cohort were 2.7% vs 1.5% and 12.4% vs 9.2%, respectively. The study cohort postoperative death rate was 0.27 per 10,000 children (95% confidence interval [CI], 0.18 to 0.39). For the study cohort, an increased risk of readmission was associated with previous urgent admission (hazard ratio [HR], 2.15; 95% CI, 1.75 to 2.63), length-of-stay ≥ four days (HR, 2.04; 95% CI, 1.57 to 2.65), Charlson comorbidity score ≥ 1 (HR, 1.61; 95% CI, 1.17 to 2.22), and age ≥ 14 yr (HR, 1.15; 95% CI, 1.02 to 1.19) or ≤ 3 yr (HR, 1.16; 95% CI, 1.15 to 1.17). Similar factors were associated with an increased risk of ED visits. Patients covered by ODB (11.8%), particularly those prescribed opioids, had an increased risk for readmission and ED visit.
Post-discharge readmissions and ED visits are relatively common after pediatric surgery, particularly for AT. Perioperative treatment algorithms that consider risk factors for hospital revisits are required in children.