A comparison study of 90-day readmission and emergency department visitation after outpatient versus inpatient pediatric pollicization surgery.

Abstract

Introduction: Transition to outpatient surgery has grown with an emphasis on delivery of safe, high-quality medical care. The purpose of this study is to compare 90-day emergency department (ED) visits, readmissions, and complications between patients undergoing outpatient versus inpatient pollicization surgery.

Methods: A single institution database was queried for primary thumb pollicization from 2010 to 2022 in patients under 18 years of age. Standard demographic data, comorbidities, surgical information, and discharge disposition were collected. Primary outcome measures were complications including ED visits, unplanned reoperations and hospital readmissions within 90-days of index procedure.

Results: Twenty-seven patients underwent pollicization surgery. Twenty patients were outpatient surgery while 7 had postoperative hospital admission, defined as an overnight hospital stay. The outpatient cohort had no major postoperative complications including no ED visits, reoperations or readmissions within 90 days of index procedure. One outpatient experienced swelling around bilateral thumb pin sites without infection or vascular compromise. One inpatient represented to the ED within 90 days of surgery for bilateral hand cellulitis.All patients with ASA I classification were performed outpatient. Three of 7 inpatients (43 %) had congenital heart disease versus 5 of the 20 (25 %) outpatients. There was a trend that inpatients were younger than the outpatient cohort (19 vs. 33 months). The average length of procedure in the inpatient cohort was significantly longer than the outpatient cohort (237 vs. 173 min). Pollicizations performed between 2017 and 2022 were more likely to be outpatient than those performed between 2010 and 2016.

Conclusion: On properly selected patients, outpatient pollicization appears to be a safe option. Patients with longer operative times were more likely to require postoperative hospital admission. Over the study years evaluated at our institution, pollicization procedures were more likely to be performed outpatient, reflecting an evolution of our practice.

Level of evidence: Level III, retrospective cohort study.