Unplanned Pediatric Surgical Readmissions: Insights from a 3-year Study at a Tertiary Care Center

A BSTRACT Aims: To determine the rate and patterns of unplanned 30-day readmissions (ReAd), compare readmission rates and examine the readmission trends in the context of quality-of-care measure assessment in pediatric surgery. Methods: A retrospective cohort study was conducted at a tertiary pediatric surgical center in Western India over a 3-year period. Children aged ≤18 years readmitted within 30 days of discharge following an elective or emergency surgical admission requiring an overnight stay were included and categorized in Group A and Group B, respectively. Data on demographics, index diagnosis, surgical procedures, comorbidities, postoperative complications, wound class, and management during readmission were analyzed. Results: Among 5230 pediatric surgical admissions, 56 unplanned readmissions were identified (readmission rate 1.07%). Readmissions were significantly higher following emergency admissions than elective procedures (3.1% vs. 0.6%; P < 0.000001). Gastrointestinal, colorectal, neurosurgical, and hepatobiliary procedures accounted for most readmissions. Nearly half of the readmitted patients required further surgical intervention, with no statistical difference between the two groups. Postoperative complication severity and wound class during the index admission were not significantly associated with operative management during readmission. Most readmissions were due to disease-specific factors, including Hirschsprung-associated enterocolitis, cholangitis following Kasai portoenterostomy, and ventriculoperitoneal shunt malfunction. Conclusions: Unplanned pediatric surgical readmissions in our setting were low (1.07%) and comparable with the international literature. Readmissions were driven mostly by emergency presentations and disease biology rather than by perioperative factors, supporting a cautious interpretation of readmission metrics as tools for quality improvement rather than standalone indicators of care quality.