A novel risk classification system for 30-day mortality in children undergoing surgery

Abstract

A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.

Epidemiological changes in child surgical activity. Analysis of 17 years in a tertiary care hospital in Mexico

“…In addition to the expected increase in the global surgical burden, the epidemiological profile [8,9] and the methods for evaluating postoperative results [9,10] are radically changing surgical planning for children [6]. In our case, the trend analysis identified changes in demographic characteristics and surgical interventions, as have also been observed in other populations [11,12].…”

Unstructured Text in EMR Improves Prediction of Death after Surgery in Children

“…For this study, death within 30 days of surgery (D30) was chosen as the main outcome variable, and other adverse events as secondary outcomes. Based on previous work by our group [3,8,9], fifteen preoperative variables were identified as risk factors of D30. Dichotomous risk factors included ventilator dependency, oxygen support, previous cardiac intervention, cerebral palsy, open wound with or without infections, neuromuscular disorder, bleeding disorder, hematologic disorder, inotropic support, blood transfusion, malignancy, do-not-resuscitate order, and neonatal status.…”

“…To make this vision a reality requires the capacity to predict uncommon events that are potentially preventable. Death after surgery in children is an infrequent occurrence, with an incidence rate of <1.0% [2,3]. Other adverse outcomes such as unplanned return to the operating room, reintubation after surgery, need for blood transfusions, and unplanned readmission are more common, with incidence rates ranging from 0.2% to 4.4% [4][5][6].…”

“…Since over 5 million operations are performed on children each year in the United States [7], even a low rate of postoperative mortality represents thousands of lives lost prematurely. The best published models predicting these events rely on structured data such as that contained in the National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) by American College of Surgeons [3,8,9]. Such models are useful in quality improvement work, risk-based payment methods, in improving surgical decision-making, and in providing accurate informed consent discussions with parents [10][11][12][13].…”

Risk assessment and anesthesia management in children with congenital heart disease undergoing non-cardiac surgery

“…The American Society of Anesthesiologist's Physical Status Score (ASA-PS) and NARCO-SS (neurological, airway, respiratory, cardiovascular, surgical score) are used in the pediatric patient group to determine the patient's risk score in the preoperative period [7]. However, as in pediatric patients with congenital heart disease, they have a limited prediction for increased mortality and morbidity of non-cardiac surgery.…”