Identifying Risk Factors for Emergency Department Return and Readmission After Pediatric Orthopaedic Surgery: A Retrospective Cohort Study.

BACKGROUND

Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery are notable burdens on the healthcare system and markers of potential gaps in patient care. The objective of this study was to identify the risk factors associated with RTED and unplanned readmissions after pediatric orthopaedic surgery.

METHODS

A retrospective cohort study was conducted between 2017 and 2023 and included patients younger than 18 who underwent orthopaedic surgery at a single, large academic institution. Patient data included current procedural terminology code, demographics, body mass index, insurance, language, and case complexity proxied by work relative value units. Procedural categories were defined by Accreditation Council for Graduate Medical Education case log guidelines for pediatric orthopaedics using current procedural terminology codes. The primary outcomes were RTED and hospital readmission within 7, 30, and 90 days of the index procedure. Univariable and multivariable logistic regression analyses were done to identify notable predictors for each outcome.

RESULTS

In total, 3,044 pediatric patients were included. In multivariable analysis, patients with Medicaid insurance had a higher odd of RTED at 30 days (odds ratio [OR] 2.26, P = 0.007) and 90 days (OR 2.39, P < 0.001), and a higher odd of readmission at 90 days (OR 3.82, P = 0.002). Hispanic ethnicity was associated with 90-day RTED (OR 1.54, P = 0.023). Black or African American race was associated with 7-day (OR 9.24, P = 0.012) and 30-day (OR 4.00, P = 0.013) readmission. After controlling for demographic variables, operations for infection (OR 15.3, P = 0.002) and soft tissue reconstruction (OR 5.45, P = 0.046) were associated with 7-day RTED. Spine deformity surgery was associated with 30-day (OR 12.0, P = 0.006) and 90-day (OR 5.19, P = 0.031) readmission.

CONCLUSION

Medicaid insurance status and the type of surgical procedure (infection, spine deformity, or soft tissue reconstruction) may represent high-risk populations for postoperative RTED and readmission. These findings underscore the need for enhanced postoperative patient support programs to mitigate adverse outcomes.