Analysis of Risk Factors Associated with Unplanned Re-Operations following Pediatric Plastic Surgery

Abstract Background/Purpose Unplanned re-operation (UR) is an outcome measure with multiple advantages that can be used as a standardized tool to assess an institution’s quality and safety of medical care. The goal of our study was to identify parameters associated with an increased likelihood of UR following plastic surgery in patients less than eighteen years of age using a large validated national multi-center database. Methods/Description We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database between years 2012 and 2014 to identify pediatric patients undergoing primary plastic surgery procedures. Two cohorts were compared: patients who experienced UR and those who did not. Multiple logistic regression analysis was utilized to identify independent risk factors associated with UR. Results A total of 18,106 patients were identified in this analysis, with an overall UR rate of 0.8% (n = 137) within 30 days after surgery. Patients were on average 5.59 ± 5.27 years of age with 9,522 boys (52.6%) and 8,584 girls (47.4%). The procedures most commonly associated with UR were excision of skin and subcutaneous tissue for hiradenitis (UR = 10.3%), forehead and/or supraorbital rim reconstruction with grafts (allograft or prosthetic material, UR = 6.1%), use of multiplane external fixators (UR = 5.6%), mastectomy for gynecomastia (UR = 4.4%), and forehead and/or supraorbital rim reconstruction with autograft (3.3%). The average number of relative value units per case was 10.01 ± 7.91. Independent risk factors for UR include inpatient procedure ( p < 0.001), ASA class 3 or higher ( p = 0.03), prolonged operative time ( p < 0.001), and prior open wound or wound infection (p = 0.05). The most significant predictors of UR were postoperative medical and surgical complications (OR, 18.92 and 39.98, respectively, p < 0.001). Conclusions With increasing focus on outcomes-driven healthcare, unplanned reoperation may be useful for monitoring quality across hospitals and identifying opportunities for quality improvement. This study provides the first analysis of risk factors associated with 30-day unplanned reoperations in pediatric plastic surgery. These results may aid in the informed consent process, improve patient risk assessment, counseling, and surgical planning.