Incidence of Unplanned Readmissions After One-Day Surgery Discharge Among Pediatric Patients: A Retrospective Study From a Tertiary Care Hospital in Saudi Arabia

Abstract

Introduction The prevalence of one-day surgery (also known as same-day surgery or outpatient surgery) has been increasing recently among patients and physicians in many countries due to its benefits. The main benefits of one-day surgery are that the patient is not planned to stay overnight before the surgery and can be discharged on the same day of the surgery. The lower cost to the health system can make these surgeries more favorable for both sides. However, unplanned readmission after such surgeries can happen and this has broad implications for patients, their families, and the healthcare system. Therefore, this study primarily aims to identify the incidence of unexpected hospital readmissions following one-day surgery after discharge among children. The study also aims to identify any significant variables that can be identified with the cases of readmissions to allow for further investigations in future studies Methods This study was done at King Abdullah Specialist Children's Hospital in Riyadh, Saudi Arabia. The target population included all pediatric patients who underwent one-day surgeries and were admitted within one week of their discharge from 2017 to 2023 through outpatient clinics and the emergency department. Results The study sample size was 403 patients, with male patients accounting for 241 surgeries (59.8%), and female patients accounting for 162 surgeries (40.1%). The most common American Society of Anesthesiologists (ASA) classification was II, accounting for 169 cases (41.9%). Toddlers and preschoolers (aged 1-6 years) were the age groups with the highest number of patients (n=252, 62.5% combined). Elective surgeries accounted for 382 cases (94.7%). The specialty with the highest number of surgeries was ear, nose, and throat with 284 cases (70.4%) with tonsillectomy with adenoidectomy being the most common surgery with 234 cases (58%). The most common reasons for unplanned readmission were poor oral intake (n=146, 36.2%) and bleeding (n=131, 32.5%). The most common day of readmission was the seventh day in five surgical specialties (45.4%). Conclusion Over the past seven years, 403 patients were readmitted within one week after their one-day surgery at King Abdullah Specialist Children's Hospital. Such a situation may cause dissatisfaction with the medical care that the patients were given and eventually may build an untrusted relationship between the patient and the physician. Future investigations should be established to lower such a condition and develop prevention methods to lower its prevalence.

Keywords: anesthesia; complication; day surgery; outpatient surgery; same day discharge; unplanned readmission.

Figure 1. Age distribution for surgical patient readmissions

The mean (dashed red line) indicates the average age of readmitted patients (i.e., approximately 5.56 years), anchoring the distribution. The density (solid blue line) represents the distribution of patient ages at readmission. The curve’s shape and peak positions suggest common ages for readmission. The section marked ±1 SD (shaded area) covers ages of approximately 22 months to 111 months (i.e., 1.86-9.25 years), indicating the most densely populated age range for readmissions.

Figure 2. Distribution of readmission days post surgery

The mean (dashed red line) marks the average number of days to readmission after surgery, at approximately 4.31 days. This value indicates a central tendency around which readmissions are most densely clustered. The density (solid blue line) portrays the probability density of readmissions on different postoperative days, where higher peaks indicate a higher rate of readmission are around that day. ±1 SD (Shaded Area): Covers the span from around 2.14 to 6.47 days post surgery, encompassing the range within which the bulk (approximately 68%) of readmission days fall.