Postoperative Disposition Following Pediatric Sistrunk Procedures: A National Database Query

Abstract

Objective/Hypothesis: Variability exists in the postoperative disposition of children following Sistrunk procedures. Management options include discharge home versus overnight observation, with the latter allowing monitoring for immediate postoperative complications, presumably reducing the need for subsequent readmission. This study investigates the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures and relevant postoperative complication and revisit rates to clarify best practice for these patients.Methods: This was a retrospective database review using the Pediatric Health Information System database from 2007 to 2016.Results: The cited dataset identified 6,434 qualifying patients, categorized into ambulatory versus overnight observation cohorts. The overall 30-day revisit rate was 4.9%; the revisit rate with overnight observation (6.1%) was higher than for ambulatory patients (3.8%, adjusted odds ratio (OR) 1.60; 95% confidence interval (CI): 1.21, 2.12). Revisit rates were significantly higher in patients 2 years of age or younger compared to older patients (6.7% vs. 4.3%). The rates of return to the operating room for the observation versus ambulatory groups were 1.8% and 0.5%, respectively. Cervical fluid collection and neck swelling were among the most common revisit indications in both groups, with a mean time to presentation of 9 days.Conclusions: This study demonstrates that ambulatory management following a Sistrunk procedure is not associated with increased rates of common postoperative complications, readmission, or need for secondary surgical intervention. A Sistrunk procedure may be safely performed on an ambulatory basis in select cases.

Risk‐adjusted analysis of perioperative outcomes after the Sistrunk procedure

“…Our rate of complications is higher than that reported in the systemic review by Gioacchini, but falls within the range of complication rates of 3.03%–39.4% in literature specific to the Sistrunk procedure in pediatric patients 19–25 . The most common complications were seroma and SSIs, which is consistent with the literature 16,21,23,26–29 . Most importantly, we found that the history of infection significantly predicted wound complications.…”

“…[19][20][21][22][23][24][25] The most common complications were seroma and SSIs, which is consistent with the literature. 16,21,23,[26][27][28][29] Most importantly, we found that the history of infection significantly predicted wound complications.…”