Advances in Pediatric Transplantation

Hepatectomy (liver resection) is uncommon in children. Hence, most studies reporting complications of hepatectomy in children and the risk factors associated with unplanned readmissions are limited to retrospective data from single centers. To better understand the risk factors for readmission after hepatectomy in pediatric patients, Columbia University researcher Mercedes Martinez, MD, Medical Director for the Intestinal Transplant Program at the Center for Liver Disease and Abdominal Organ Transplantation, and her colleagues, including Elise Kang, MD, Steven Lobritto, MD, Dana Goldner, MD, and Steven Stylianos, MD, explored the risk factors for 30-day unplanned readmission after hepatectomy in children using the American College of Surgeons National Surgical Quality Improvement-Pediatric database.

For the study, the Columbia University researchers queried the database for patients aged 0-18 years who underwent hepatectomy to treat liver lesions from 2012 to 2018. Chi-squared tests were performed to evaluate potential risk factors for unplanned readmissions. A multivariate regression analysis was performed to identify independent predictors for unplanned 30-day readmissions.

• Unplanned readmissions after liver resection are frequent in pediatric patients. Of the 438 children undergoing hepatectomy, 64 (14.6%) had unplanned readmissions. The median age of the hepatectomy cohort was 1 year (0-17); 55.5% were male.
• Patients readmitted had significantly higher rates of esophageal/gastric/intestinal disease (26.56% vs. 14.97%; p=0.022), current cancer (85.94% vs. 75.67%; p=0.012), and enteral and parenteral nutritional support (31.25% vs. 17.65%; p=0.011).
• Readmitted patients had significantly higher rates of perioperative blood transfusion (67.19% vs. 52.41%; p=0.028), organ/space surgical site infection (10.94% vs. 1.07%; p<.001), sepsis (15.63% vs. 3.74%; p<.001), and total parenteral nutrition at discharge (9.09% vs. 2.66%; p=0.041).
• Organ and space surgical site infections may be a useful way to identify patients at increased risk for unplanned readmission. Based on multivariate analysis, the organ/space surgical site infection was an independent risk factor for unplanned readmission (OR=9.598, CI [2.070-44.513], p=0.004).

The Columbia researchers conclude that strategies to reduce these complications may decrease morbidity and costs associated with unplanned readmissions.