Unplanned readmission after cranial tumor surgery in the pediatric National Surgical Quality Improvement Program.
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OBJECTIVE: Hospital readmissions are commonly considered an indicator of healthcare quality. The key assumption is that readmissions are preventable, which is especially important in a pediatric population heavily reliant on Medicaid. The aim of this study was to understand the rate, demographics, and independent predictors of unplanned 30-day readmission after pediatric craniotomy for tumor. METHODS: A review of the prospective pediatric National Surgical Quality Improvement Program database was performed to identify patients who underwent craniotomy for tumor from 2012 to 2021. The primary outcome was unplanned 30-day readmission, with secondary outcomes of 30-day reoperation or 30-day death. Multivariable logistic regression models were applied to patient characteristics, comorbidities, and surgical factors to identify independent predictors. RESULTS: Overall, 9845 patients (55% male, mean age 9 years) were included, of which 9.8% had unplanned readmission, 10.8% underwent reoperation, and 0.8% died within 30 days. The cohort was predominantly of White race and primarily underwent elective surgery. Not surprisingly, reoperation was a strong predictor of readmission; however, other predictors included steroid use and nutritional support. Notably, operative factors such as the duration of surgery or the need for blood transfusion were not predictors of any outcome measured. Independent predictors of reoperation included patient comorbidities, as well as preoperative characteristics and case type. Predictors of 30-day death included emergency surgery, ventilator dependence, nutritional support, and hematological disorders. CONCLUSIONS: There were identifiable factors associated with readmission, reoperation, and death among pediatric patients who underwent craniotomy for tumor. Attention to these factors during clinical care could contribute to risk stratification, patient and family education, and transitional care advising.