Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery

Sethi, Mohammad Valeed Ahmed; Zimmer, Julia; Ure, Benno M.; Lacher, Martin

doi:10.1016/j.jpedsurg.2015.10.052

Cited by 20 publications

(22 citation statements)

References 22 publications

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“…Although medical records were reviewed to gather information on treatment-related factors and complications, these were not always reported in a standardized manner and were based on the clinical opinion of the evaluating physician or nurse practitioner. As observed in previous studies, complication registration in medical records may be incomplete [20,21], which could have reduced the accuracy of the model.…”

Section: Strengths and Limitationsmentioning

confidence: 87%

Development of a prediction model for postoperative complications after primary hypospadias correction

Dokter¹,

Zanden²,

Laumer³

et al. 2020

Journal of Pediatric Surgery

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To develop a prediction model for postoperative complications after primary one-stage hypospadias correction to improve preoperative parental counseling. Materials and methods: In this retrospective cohort study, data were collected from 356 patients with anterior or middle hypospadias who had a one-stage hypospadias correction from 2003 onwards. Potential treatment-and patient-related factors were selected and used to develop a prediction model for postoperative complications within one year (wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications). Multivariable logistic regression analysis with stepwise backward selection and a p-value of 0.20 was used to select the final model, which was internally validated using the bootstrap procedure. Results: Complications within one year postoperatively occurred in 66 patients (19%), of which 13% and 37% were seen in anterior and middle type of hypospadias, respectively. Hypospadias phenotype, surgical technique, chordectomy, and surgeon's experience were included in the final prediction model, whereas none of the patientrelated factors were. The final model had a good discriminative ability (bias corrected C statistic 0.70) and calibration. Conclusion: Using easily obtainable information, this model showed good accuracy in predicting complications within one year after hypospadias surgery. It is a first step towards individualized risk prediction of postoperative complications for anterior and middle hypospadias and can assist in preoperative parental counseling.

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Section: Strengths and Limitationsmentioning

confidence: 87%

Development of a prediction model for postoperative complications after primary hypospadias correction

Dokter¹,

Zanden²,

Laumer³

et al. 2020

Journal of Pediatric Surgery

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“…We chose the Clavien-Dindo Classification because, even if it was designed for adults, it has been found to have high sensitivity for pediatric urology, oncology and also neonatal surgery. Its merit is that it moved the focus from the mere occurrence of complications to the grade of complication as a function of the resulting outcome (15).…”

Section: Discussionmentioning

confidence: 99%

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

et al. 2019

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Introduction: The surgical technique for peripheral cannulation aimed at providing extracorporeal membrane oxygenation (ECMO) is well described. Training methods for surgeons still need proper standardization, especially in newborn patients. This study aims to evaluate the surgical training outcomes of a neonatal ECMO team.Materials and Methods: A 4 year training program (2014–2018) was developed to achieve the skills in the surgical technique for neonatal veno-arterial ECMO. Surgeons with experience in neonatal and vascular surgery were selected for the training. The training consisted of educational sessions, high-fidelity simulations, in vivo swine model procedures, international fellowship, and periodical simulations. The preliminary clinical experience in surgical neonatal ECMO management (2016-present) was analyzed by recording the following data: indications for ECMO and patients' data; effectiveness of cannulations (number; perioperative complications of cannulation; major surgical events during ECMO); efficacy of decannulation (number and perioperative complications).Results: 12 neonates (5 females) fitted the ELSO criteria for ECMO. Nine newborns were affected by CDH; 1 by H1N1 flu-related pneumonia; 1 by meconium aspiration syndrome and one by Respiratory Syncytial Virus related bronchiolitis. Mean weight at cannulation was 3,281 g (range 2,330–3,840 g); mean gestational age was 36 weeks. No procedure was aborted, and no intra-operatory mortality was recorded. Mean operative time was 86 ± 30 min. The caliber of the carotideal cannulas ranged from 8F (8 patients) to 10F (2 patients); the caliber of the jugular cannulas were: 8F cannula (2 patients), 10F (6 patients), and 12F (2 patients). Four complications occurred: a case of air in the circuit, two cases of azygous vein cannulation and a partial dislocation of the venous cannula during the daily care maneuvers. All of them were promptly recognized and successfully treated. The mean ECMO duration was 7.1 ± 4.2 days (range 2–16 days). Seven patients (78%) were decannulated effectively. Mean decannulation time was 53 min (range 45–80 min). No complications occurred during the decannulation process. No ECMO–related deaths were recorded.Conclusions: Neonatal respiratory ECMO still represents a challenge. Experienced neonatal surgeons can manage the neck vascular cannulation. The codified procedure must be adhered to after appropriate training and following a proper learning curve.

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“…SSIs and resulting procedures were prospectively documented on a daily basis during each morning report according to Sethi et al 10 Primary end point of the study was the incidence of a SSI as defined by Horan et al 11 Therefore, a superficial incisional SSI must meet the following criteria: The infection occurs within 30 days after the operative procedure and involves only skin or subcutaneous tissue of the incision, and at least one of the following is present: (1) Purulent drainage from the superficial incision. (2) Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.…”

Section: Methodsmentioning

confidence: 99%

Negative Pressure Wound Dressing Reduces Surgical Site Infections in Infants after Closed Abdominal Procedures: A Preliminary Report

et al. 2018

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Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery

Cited by 20 publications

References 22 publications

Development of a prediction model for postoperative complications after primary hypospadias correction

Development of a prediction model for postoperative complications after primary hypospadias correction

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Negative Pressure Wound Dressing Reduces Surgical Site Infections in Infants after Closed Abdominal Procedures: A Preliminary Report

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