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Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital
Benjamin F van der Griend1, Nichole A Lister, Ian M McKenzie
1Christchurch Hospital, Christchurch, New Zealand. ben@vandergriend.com
Insights
Pediatric anesthesia is generally safe for healthy children. However, anesthesia-related mortality is higher in children with heart disease, especially pulmonary hypertension, highlighting the need for careful management in these cases.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Public Health
Background:
- Mortality data are crucial for assessing anesthesia quality and safety, yet limited data exist for pediatric anesthesia.
- This study aimed to determine 24-hour and 30-day mortality rates following anesthesia in children.
- The research also focused on identifying the incidence and nature of anesthesia-related mortality in pediatric patients at a major tertiary hospital.
Purpose of the Study:
- To ascertain the incidence of 24-hour and 30-day mortality in pediatric patients post-anesthesia.
- To investigate the incidence and characteristics of anesthesia-related mortality in pediatric practice.
- To evaluate the safety of pediatric anesthesia, particularly in healthy versus comorbid children.
Main Methods:
- A retrospective analysis of children (≤ 18 years) who received anesthesia between January 2003 and August 2008 at a tertiary institution.
- Data linkage between anesthetic records and mortality databases to identify all deaths within 24 hours and 30 days of anesthesia.
- Anesthesia-related death was defined by consensus among three senior anesthesiologists, indicating anesthesia influenced the timing of death.
Main Results:
- Over 100,000 anesthetics were administered to over 56,000 children during the study period.
- Overall 24-hour mortality was 13.4/10,000 anesthetics, and 30-day mortality was 34.5/10,000 anesthetics.
- Ten anesthesia-related deaths occurred (0.98 per 10,000 anesthetics), with pre-existing conditions, particularly pulmonary hypertension, being significant factors in all cases.
Conclusions:
- Anesthesia-related mortality in children is elevated in those with heart disease, especially pulmonary hypertension.
- The findings suggest that pediatric anesthesia is safe for healthy children with no major comorbidities.
- Risk stratification and careful anesthetic management are essential for pediatric patients with significant underlying health issues.
Background:
Mortality is a basic measure for quality and safety in anesthesia. There are few anesthesia-related mortality data available for pediatric practice. Our objective for this study was to determine the incidence of 24-hour and 30-day mortality after anesthesia and to determine the incidence and nature of anesthesia-related mortality in pediatric practice at a large tertiary institution.
Methods:
Children ≤ 18 years old who had an anesthetic between January 1, 2003, and August 30, 2008, at the Royal Children's Hospital, Melbourne, Australia, were included for this study. Data were analyzed by merging a database for every anesthetic performed with an accurate electronic record of mortality of children who had ever been a Royal Children's Hospital patient. Cases of children dying within 30 days and 24 hours of an anesthetic were identified and the patient history and anesthetic record examined. Anesthesia-related death was defined as those cases whereby a panel of 3 senior anesthesiologists all agreed that anesthesia or factors under the control of the anesthesiologist more likely than not influenced the timing of death.
Results:
During this 68-month period, 101,885 anesthetics were administered to 56,263 children. The overall 24-hour mortality from any cause after anesthesia was 13.4 per 10,000 anesthetics delivered and 30-day mortality was 34.5 per 10,000 anesthetics delivered. The incidence of death was highest in children ≤ 30 days old. Patients undergoing cardiac surgery had a higher incidence of 24-hour and 30-day mortality than did those undergoing noncardiac surgery. From 101,885 anesthetics there were 10 anesthesia-related deaths. The incidence of anesthesia-related death was 1 in 10,188 or 0.98 cases per 10,000 anesthetics performed (95%confidence interval, 0.5 to 1.8). In all 10 cases, preexisting medical conditions were identified as being a significant factor in the patient's death. Five of these cases (50%) involved children with pulmonary hypertension.
Conclusions:
Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children.
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