Major morbidity and mortality associated with delays to emergent surgery in children: a risk-adjusted analysis

Abstract

Background: Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population. Methods: We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children’s Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ 2 test for univariate analysis and logistic regression for multivariate analysis. Results: There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d–18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20–2.94) compared to no delay. Conclusion: Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.

Co-Incidence of Intussusception and Appendicitis in a 10-Month-Old Infant

“…Delay in initiating emergency surgery is associated with a significant increase in morbidity and mortality. 8 In our case, we did not perform CT examination as the patient presented with obvious peritoneal signs and there was a possibility of intestinal perforation after previous hydrostatic reduction. Therefore, immediate surgical intervention was performed.…”

Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life—A Narrative Review

“…Long wait times from surgical back log in addition to limited operating room space also contribute to delayed surgical interventions that turn elective surgical conditions in emergent ones. Thus, the missed opportunities to intervene convert conditions that are correctable into ones with a higher likelihood for complications and mortality [ 67 ].…”