Objective: To determine the incidence, diagnoses, and risk factors associated with 30-day unplanned revisits following ambulatory pediatric sinus surgery.
Study Design: Cross‐sectional analysis using national database.
Methods: We analyzed the State Ambulatory Surgery and Services, Emergency Department, and Inpatient Database from California for children under 18 years of age who underwent sinus surgeries between the years 2008 and 2011. Rates, diagnoses, and patient-level risk factors for 30-day readmissions were examined. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30-day revisits.
Results: A total of 6,924 ambulatory sinus surgeries were performed in the 3 year period (mean age 3 years, 60.7% male). The 30-day unplanned revisit rate was 5.3% after surgery. Of all readmissions, 53.4% (173) were due to adenoidectomy. The most common readmission diagnoses were due to direct anesthesia complications (12.3%) [i.e. nausea, vomiting] and postoperative bleeding (10.2%). On univariate analysis, factors statistically significantly associated with hospital revisit were Black race (vs white: OR 1.92; 95% CI 1.12 – 3.29), Hispanic race (vs white: OR 1.56; 95% CI 1.16 – 2.11), Adenoidectomy (OR 0.53; 95% CI 0.32 to 0.87), and Private payer status (OR 0.47; 95% CI 0.37 to 0.60). On multivariate regression, statistically significant negative predictors for revisit were adenoidectomy (OR 0.37; 95% CI 0.19 – 0.71) and Private payer status (OR 0.44; 95% CI 0.31 – 0.61).
Conclusion: Our study demonstrated that 1 in 19 patients undergoing ambulatory sinus surgery revisit the hospital within 30 days. Revisits are most commonly due to anesthesia complications and post-operative bleeding. These specific complications should be a target for prevention to minimize post-operative revisit rates and improve quality of care. Insurance status and procedural type are important predictors for revisits and should be incorporated in risk-adjustment models of a hospital’s patient populations to avoid unfair penalties.