Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies In Children and In-Hospital Postoperative Outcome

2021

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Background Reported independent predictors of intraoperative and postoperative complications were Age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection. Objectives To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization. Methods Secondary analysis of the initial study. The Ethics Committee approved the study. Results There were 54 patients with a median age of 15.5[0–172] months. Thirty-seven (68.5%) patients had an intestinal resection, nine (16.7%) had an exploratory laparotomy and eight (16.8%) patients had a laparotomy for volvulus.

Section: Discussionsupporting

confidence: 62%

Exploratory Laparotomy, Intestinal Resection In Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021

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“…Intraoperative optimization with goal-directed therapies could contribute to upgrading postoperative outcomes in these surgical settings (11,12,13,14,15,16,17,18,19,20,21). Similar conclusions have been drawn in major surgical settings and where goal-directed therapies need to be developed and applied systematically to improve postoperative outcomes (22,23,24,25).…”

Section: Discussionsupporting

confidence: 59%

Exploratory Laparotomy and Intestinal Resection in Children: Intraoperative Goal Directed Therapy and Intraoperative and Postoperative Outcomes

2021

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Background: Reported independent predictors of intraoperative and postoperative complications were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection.Objectives: To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization.Methods: Secondary analysis of the initial study. The Ethics Committee approved the study.Results: There were 54 patients with a median age of 15.5[0-172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus.Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had intraoperative hemorrhagic shock. Two (3.7%) patients had postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had intraoperative transfusion. The in-hospital mortality rate was 3.7% in two patients.Conclusion: Intraoperative goal-directed therapies need to be developed and included in these surgical settings for intraoperative and postoperative optimization.

“…This protocol will clarify the impact of this validated tool on postoperative outcomes in pediatric surgical patients (16,17). Similar conclusions have been drawn in other major pediatric surgical settings where goal-directed therapies need to be developed in research protocols to determine their impact on postoperative outcomes (11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 59%

“…The results of this secondary analysis highlight that morbidity in terms of postoperative organ dysfunction and infection in patients who underwent exploratory laparotomy and intestinal resection was high. Similar analyses have been conducted in other surgical pediatric settings (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). How could these outcomes be improved?…”

Section: Discussionmentioning

confidence: 73%

Postoperative Outcomes in Exploratory Laparotomy and Intestinal Resection in Children: A Secondary Descriptive Observational Analysis

2021

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Background: We previously reported independent predictors of intraoperative and postoperative morbidity. These were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of this previous retrospective study in patients who underwent exploratory laparotomy and intestinal resection.Objectives: To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to present a research protocol for intraoperative and postoperative optimization.Methods: Secondary analysis of the initial study. The Ethics Committee approved the study.Results: There were 54 patients with a median age of 15.5[0-172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus.Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had intraoperative hemorrhagic shock. Two (3.7%) patients had postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had intraoperative transfusion.The in-hospital mortality rate was 3.7% in two patients.Conclusion: The number of patients with postoperative complications in this cohort was not negligible. We therefore elaborated a research protocol where intraoperative patient management will be guided with transthoracic echocardiography for fluid and hemodynamic therapy optimization. The objectives of this study protocol are to clarify the impact of intraoperative goal-directed fluid and hemodynamic therapy with transthoracic echocardiography on postoperative outcomes in terms of complications in pediatric surgical patients.