Predictors of 30-day Readmission or Reoperation After Pediatric Cochlear Implantation: A National Database Study

Introduction: The goal of this study is to identify demographic and clinical predictors of 30-day related readmission or reoperation following pediatric cochlear implantation using a national surgical database

Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database (2019–2023). Patients < 18 years undergoing cochlear implant (CPT 69930) were included. Clinical and demographic characteristics were compared across racial and ethnic groups using Chi-square and Fisher’s exact tests, with adjusted standardized residuals used for post-hoc identification of significant associations. Continuous variables were evaluated via one-way ANOVA or Welch’s ANOVA with Games–Howell post-hoc testing based on homogeneity of variance. Multivariable logistic regression was used to identify independent predictors of 30-day related readmission or reoperation, and model discriminative ability was assessed via the C-statistic.

Results: Of 8,367 patients, 1.3% (n=108) experienced a 30-day related readmission or reoperation. The most common indications were infection (n=48) and implant-related complications (n=11). Multivariable analysis revealed that younger age (aOR 0.90 per year; 95% CI 0.86–0.96; p < 0.001) and inpatient case classification (aOR 1.77; 95% CI 1.10–2.86; p = 0.019) were significant predictors of the primary outcome. Among comorbidities, gastrointestinal and nutritional disease significantly increased risk (aOR 1.90; 95% CI 1.00–3.58; p = 0.049). Hispanic ethnicity was associated with higher odds of readmission (aOR 1.69; 95% CI 1.02–2.80; p = 0.042), while "Other" race was protective (aOR 0.48; 95% CI 0.26–0.88; p = 0.018).

Conclusions: Readmission and reoperation following pediatric cochlear implantation is rare but is significantly influenced by age, surgical setting, and specific nutritional comorbidities. Disparities in outcomes based on ethnicity suggest a need for targeted perioperative support for high-risk populations to ensure equitable surgical care.