13.13 Examination of Postoperative Length of Stay Following Common Procedures in ACS-NSQIP Pediatric

D. Papandria¹, Y. V. Sebastião¹, K. J. Deans¹, K. A. Diefenbach¹, P. C. Minneci^{1  1}Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OH, USA

Introduction:

Though frequently reported in comparative studies, there are few reports describing typical postoperative length of stay (LOS) associated with commonly performed operations in the pediatric population. The objective of this study was to identify ranges of postoperative LOS for common pediatric procedures using a large multi-institutional database.

 

Methods:

A retrospective analysis of the ACS-NSQIP Pediatric Public Use File (2013-2015) was performed. General surgical procedures were grouped using Current Procedural Terminology codes (CPTs). The most frequently performed procedures were identified and analyzed. These included: laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), laparoscopic gastrostomy (LG), laparoscopic esophagogastric fundoplication (LF), thoracoscopic repair of pectus excavatum (TPE), appendectomy (OA), enterostomy closure (OEC), gastrostomy closure (OGC), and bowel resection (OBR). Patients < 6 months or > 18 years of age and those receiving unrelated major concurrent surgical procedures were excluded, as were day-of-surgery discharges and inpatient deaths. Postoperative LOS was examined for each procedure, including multivariable analysis of patient preoperative risk factors for postoperative LOS > 75th percentile.

 

Results:

A total of 29, 557 cases were identified (median age: 7 years; 57% male; 73% white), and included procedure subgroups ranging from 505 (OBR) to 19,260 (LA) cases. Procedure-specific median postoperative LOS (75^th percentile; 90^th perecentile) were: LA 1d (2d; 5d); LC 1d (1d; 2d); LG 2d (2d, 4d); LF 3d (4d, 6d);  TPE 4d (5d, 6d);  OA 3d ( 6d, 9d);  OEC 4d (6d, 10d);  OGC 1d (1d, 2d); and OBR 6d (10d, 20d)(Fig. 1). Preoperative risk factors for high postoperative LOS varied by procedure and included patient demographics (age, race), admission factors (inpatient classification, admission from Emergency Dept.), case characteristics (emergent designation, ASA class III / IV), and comorbidities (sepsis, developmental delay, neurologic disease). No single risk factor reached statistical significance for more than six of the procedures.

 

Conclusion:

The range of postoperative LOS for commonly performed procedures varies considerably across procedures. Risk factors for high postoperative LOS also varied by procedure. These results may be a useful reference for benchmarking and resource utilization analyses at the institutional and health systems levels.