Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index

Tejwani, Rohit; Lee, Hui‐Jie; Hughes, Taylor L.; Hobbs, Kevin T.; Aksenov, Leonid; Scales, Charles D.; Routh, Jonathan C.

doi:10.1016/j.jpurol.2022.03.007

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…Созданная нами шкала наряду с базовой системой Аристотеля позволяет прогнозировать ближайшие и отдалённые осложнения после операции. Данная оценка позволила дать объяснение в случаях, когда у разных пациентов с одинаковым типом ВПС и стандартным хирургическим вмешательством по-разному протекает постоперационный период и различаются исходы, что важно также для информированности родителей пациентов [19][20][21]. Шкала стратификации представляет собой необходимый и объективный инструмент, обладающий превосходной способностью прогнозировать периоперационные риски смертности у педиатрических пациентов, перенёсших кардиохирургические вмешательства, или в дооперационном периоде, что может быть использовано клиницистами для повышения эффективности работы.…”

Section: Discussionunclassified

Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Sarsenbaeva,

Berdibekov

2023

RPJ

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Mortality-based comorbidity indices worldwide have had mixed success in adjusting for risk in children. Despite numerous attempts to predict perioperative mortality and complications after cardiac surgery in adults, an objective model for predicting risks in children has not been developed. The purpose of the study: to analyze the frequency and structure of comorbidities and conditions in children with cardiac surgical pathology in order to assess the perioperative risks of complications and implement their own prognostic risk scale. Materials and methods. A comprehensive analysis of five hundred cardiac surgery patients hospitalized in the Department of Cardiac Surgery for the period of 2017–2023 was carried out, and there was studied the autopsy material of 350 patients with congenital heart defects according to the pathoanatomical bureau. Patients underwent standard research methods: echocardiography, chest X-ray, neurosonography and abdominal ultrasound, clinical and laboratory studies, blood for IUI, for procalcitonin, immunogram, angiocardiography, CT and MRI according to indications, bacteriological studies of smears, plain radiography of the abdominal cavity in the standard positions, trepanobiopsy, and genetic studies according to indications. Results. A classification of common comorbidities in pediatric cardiac surgery patients is presented and a stratification scale of comorbidity is developed. A high incidence of comorbidity in cardiac surgery patients (70%) and its impact on preoperative and postoperative management, timing of surgery and the development of complications, and financial risks are shown. It is shown that, along with the Aristotle cardiac surgical scale, the surgical risk assessment based on comorbidity developed by us improves the awareness of patients’ parents about the prognosis and risks of heart and vascular surgery. Conclusion. Evaluation of the role of the coexistence of extracardiac congenital malformations, genetic anomalies and syndromes, metabolic diseases in cardiac surgical patients can significantly affect surgical and therapeutic strategies and outcomes. Early identification of children at high risk of complications and death through the use of different stratification scales can lead to improved treatment outcomes.

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Section: Discussionunclassified

Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Sarsenbaeva,

Berdibekov

2023

RPJ

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“…Статистические инструменты и модели риска, которые были разработаны для взрослых пациентов с приобретёнными сердечно-сосудистыми заболеваниями, не могут быть просто применены к детям и взрослым с ВПС [4][5][6]. В настоящее время детские кардиохирурги активно обсуждают подходящие шкалы оценки рисков для кардиохирургического больного детского возраста [7,8]. Существующие шкалы рисков в детской кардиохирургии (шкала Аристотеля, RACHS-1 и RACHS-2) не лишены значительных недостатков, обладают ограниченной прогностической ценностью и не содержат всех необходимых переменных факторов риска [9][10][11].…”

Section: актуальностьunclassified

Extracardial pathology as an additional risk factor in the correction of congenital heart defects in children

Sarsenbaeva

2024

RPJ

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Introduction. Concomitant diseases as a risk factor for surgery remain an urgent problem in pediatric cardiac surgery. The article presents the role of comorbidity in pediatric cardiac surgery. A comparative analysis of the indicators of cardiac surgical treatment of patients with and without extracardiac pathology was carried out. Aim: to determine the significance of extracardiac causes as an additional risk factor in the correction of congenital heart lesions in children. Materials and methods. Prospective analysis of five hundred patients who had undergone cardiac surgery in the departments of cardiac surgery and interventional cardiology. Patients were divided into a main group of patients with concomitant pathology (n = 350) and a control group (n = 150) without concomitant pathology. A complex of modern therapeutic and diagnostic procedures and a multidisciplinary approach were used. Results. A high incidence of complications was shown in the main group (70%). Hospital mortality was higher in patients with concomitant pathology and amounted to 17.4%, compared to 3.3% in the group without concomitant pathology. The average duration in the ICU for patients with concomitant pathology was 18 ± 2 bed days, for patients without concomitant pathology — 4 ± 2 bed days. Conclusion. The presence of concomitant pathology has been shown to influence significantly on the development of complications and be a prognostic risk factor that must be included in modern prediction models.

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Lack of Association of Pediatric Surgical Patient Outcomes With Increased Disposable Operating Room Supply Costs

Acker,

Prendergast,

Inge

et al. 2024

Journal of Pediatric Surgery

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Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index

Cited by 5 publications

References 27 publications

Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Extracardial pathology as an additional risk factor in the correction of congenital heart defects in children

Lack of Association of Pediatric Surgical Patient Outcomes With Increased Disposable Operating Room Supply Costs

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