Analysis of risk factors for unplanned readmission following acute appendicitis surgery in children.

BACKGROUND

Acute appendicitis (AA) is the most common acute abdominal condition in children. The rate of unplanned readmission within 30 days after appendectomy ranges from 4% to 13%, significantly increasing the healthcare burden and affecting patient outcomes. Identifying independent risk factors for readmission is crucial for optimizing management of high-risk pediatric patients; however, relevant evidence in the Chinese pediatric population remains limited.

METHODS

This study employed a single-center retrospective cohort design, enrolling 5,016 pediatric patients who underwent appendectomy for AA at Wuhan Children's Hospital between July 2013 and February 2025. Perioperative variables were collected via the electronic medical record system, including demographic characteristics, inflammatory markers (WBC, CRP), surgical approach (laparoscopic/open), and appendicitis classification (complicated appendicitis /uncomplicated appendicitis). The primary outcome was unplanned readmission within 30 days after discharge following appendectomy. Multivariate logistic regression analysis was performed to identify independent risk factors (SPSS 27.0), with collinearity diagnostics to ensure model stability. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for continuous variables.

RESULTS

The overall readmission rate was 2.4% (118/5,016), with 17.8% (21/118) requiring reoperation. Primary readmission causes included intra-abdominal infection (39.8%), intestinal obstruction (36.4%), and surgical site infection(SSI) (17.8%). 71.2% of readmissions occurred within ≤ 14 days post-discharge (median: 11 days). Independent risk factors included open surgery (aOR = 6.92, 95% CI: 3.65-13.13, P < 0.001), CRP ≥ 53.36 mg/L (aOR = 4.28, 95% CI: 2.62-6.98, P < 0.001), complicated appendicitis (aOR = 1.56, 95% CI: 1.03-2.37, P = 0.037), and operative time > 63.5 min (aOR = 1.82, 95% CI: 1.25-2.66, P = 0.002).

CONCLUSION

Open surgery, elevated CRP (≥ 53.36 mg/L), complicated appendicitis, and prolonged operative time are independent risk factors for readmission following pediatric appendectomy. For children exhibiting these high-risk characteristics, individualized discharge follow-up strategies (e.g., early outpatient evaluation, enhanced complication monitoring) are recommended to reduce readmission risk. Future research should develop predictive risk models and validate the effectiveness of intervention measures.