Factors associated with unplanned readmissions in pediatric surgical oncology patients

Abstract

Purpose

Pediatric oncology patients are at increased risk of unplanned readmissions, but factors associated with readmissions are largely unknown. We aimed to identify patients at increased risk for readmission and characterize unplanned readmissions for pediatric surgical oncology patients.

Methods

Patients < 20 years with a first primary solid organ cancer who underwent definitive oncologic surgery from 2005–2017 were identified in the California Cancer Registry linked to statewide hospitalization data. Unplanned 30-day readmissions from their definitive surgery were defined as acute medical problems and/or surgical complications not related to planned admissions for chemotherapy, radiation, or rehabilitation. Multivariable logistic regression identified factors associated with unplanned 30-day readmission.

Results

2507 pediatric oncology patients were identified. Median age was 10 years. 49.2% had a 30-day readmission (n = 1233), and 36.7% (n = 452) of these readmissions were unplanned. In multivariable models, those at highest risk of unplanned readmission were < 1 year old (OR 2.72, CI 1.72–4.29) and 1–5 years (OR 1.64, CI 1.20–2.24) vs. ages 13–19; had metastatic disease at diagnosis (OR 1.6, CI 1.1–2.1); and had central nervous system (CNS) tumors (OR 2.5, CI 1.6–3.9), hepatic tumors (OR 2.3, 95% CI 1.2–4.2), or soft tissue/extraosseous sarcomas (OR 2.2, CI 1.3–3.9). Longer initial hospitalizations were associated with a higher likelihood of unplanned readmission (10 days vs. 7 days, p < 0.0001).

Conclusion

Unplanned readmissions after surgery for pediatric oncology patients are prevalent. Younger children and those with more advanced/complex disease are at highest risk of unplanned readmissions. Interventions should focus on preventing readmissions in these patients, specifically.