Corrigendum to ‘Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group’ [Br J Anaesth 2019; 122: 215–223]

Goobie, Susan M.; Zurakowski, David; Isaac, Kathryn V.; Taicher, Brad M.; Fernandez, Patrick; Derderian, Courtney K.; Hetmaniuk, Mali; Stricker, Paul A.

doi:10.1016/j.bja.2019.02.001

Cited by 9 publications

(15 citation statements)

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“…These results agree with and confirm other published work in the area 21,22 . Our results show that ASA score predicts children at risk for poor outcomes.…”

Section: Discussionsupporting

confidence: 93%

Network Analysis of Postoperative Surgical Complications in a Cohort of Children Reported to the National Surgical Quality Improvement Program

et al. 2020

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Objective:To understand the temporal relationships of postoperative complications in children and determine if they are related to each other in a predictable manner.Summary of Background Data:Children with multiple postoperative complications have increased suffering and higher risk for mortality. Rigorous analysis of the temporal relations between complications, how complications might cluster, and the implications of such clusters for children have not been published. Herein, we analyze the relationships between postoperative complications in children.Methods:Data source: Surgical operations included in the National Surgical Quality Improvement Program Pediatric Participant Use Data File from 2013 to 2017. The main outcomes measure was presence of 1 or more postoperative complications within 30 days of surgery. Operations followed by multiple complications were analyzed using network analysis to study prevalence, timing, and co-occurrences of clusters of complications.Results:This study cohort consisted of 432,090 operations; 388,738 (89.97%) had no postoperative complications identified, 36,105 (8.35%) operations resulted in 1 postoperative complication and 7247 (1.68%) operations resulted in 2 or more complications. Patients with multiple complications were more likely to be younger, male, African American, with a higher American Society of Anesthesiologists score, and to undergo nonelective operations (P < 0.001). More patients died with 2 complication versus 1 complication vs no complication (5.3% vs 1.5% vs 0.14%, P < 0.001). Network analysis identified 4 Louvain clusters of complications with dense intracluster relationships.Conclusions:Children with multiple postoperative complications are at higher risk of death, than patients with no complication, or a single complication. Multiple complications are grouped into defined clusters and are not independent.

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“…These results agree with and confirm other published work in the area 21,22 . Our results show that ASA score predicts children at risk for poor outcomes.…”

Section: Discussionsupporting

confidence: 93%

Network Analysis of Postoperative Surgical Complications in a Cohort of Children Reported to the National Surgical Quality Improvement Program

et al. 2020

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“…There are several recently published studies detailing complications following pediatric craniosynostosis surgery. 4–8 In 2017, the Pediatric Craniofacial Surgery Perioperative Registry assessed 1223 cases from 31 institutions across the United States from June 2012 to September 2015 and presented a comprehensive overview of the perioperative management, outcomes, and intraoperative complications, which included cardiac arrest (0.2%), hypotension (5.3%), bradycardia requiring treatment (1.6%), suspected venous air embolism (1.1%), and large-volume (>40 mL/kg) blood transfusion (26.8.1%) but no deaths. 8 This study highlighted the large variability in perioperative management and outcomes and opportunities for improvement.…”

Section: Discussionmentioning

confidence: 99%

“…A follow-up study from the same Pediatric Craniofacial Collaborative Group analyzed 1814 patients from 33 centers and demonstrated a 15% incidence of major perioperative complications following pediatric cranial vault reconstruction. 7 Multivariable predictors included ASA status III or IV, syndrome, nonusage of antifibrinolytics, blood product transfusion of more than 50 mL/kg, and surgical duration over 5 hours. No deaths were reported.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Kennedy

Novak

Phillips

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the incidence and acute outcomes of catastrophic and critical events during craniofacial surgery at a single high-volume center. Methods: The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed. Results: This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients. Conclusions: Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities.

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“…However, a multicenter observational study reports that TXA administration in pediatric craniofacial surgery is independently associated with a 37% reduction in the odds of a major perioperative adverse event. 142 Absolute contraindications for the pediatric patient include hypersensitivity, active thromboembolic disease, and fibrinolytic conditions with consumption coagulopathy. 16 Relative contraindications should take into consideration the risk-to-benefit ratio.…”

Section: Txa Safety and Contraindicationsmentioning

confidence: 99%

Update on Applications and Limitations of Perioperative Tranexamic Acid

Patel

Wyrobek

Butwick

et al. 2022

Anesthesia &Amp; Analgesia

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Tranexamic acid (TXA) is a potent antifibrinolytic with documented efficacy in reducing blood loss and allogeneic red blood cell transfusion in several clinical settings. With a growing emphasis on patient blood management, TXA has become an integral aspect of perioperative blood conservation strategies. While clinical applications of TXA in the perioperative period are expanding, routine use in select clinical scenarios should be supported by evidence for efficacy. Furthermore, questions regarding optimal dosing without increased risk of adverse events such as thrombosis or seizures should be answered. Therefore, ongoing investigations into TXA utilization in cardiac surgery, obstetrics, acute trauma, orthopedic surgery, neurosurgery, pediatric surgery, and other perioperative settings continue. The aim of this review is to provide an update on the current applications and limitations of TXA use in the perioperative period. (Anesth Analg 2022;135:460-73)

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Corrigendum to ‘Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group’ [Br J Anaesth 2019; 122: 215–223]

Cited by 9 publications

References 0 publications

Network Analysis of Postoperative Surgical Complications in a Cohort of Children Reported to the National Surgical Quality Improvement Program

Network Analysis of Postoperative Surgical Complications in a Cohort of Children Reported to the National Surgical Quality Improvement Program

Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Update on Applications and Limitations of Perioperative Tranexamic Acid

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