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[Surgical risk scale in pediatric surgery]
1Servicio de Trasplante Hepático, Hospital Nacional de Pediatría Juan P. Garrahan, Buenos Aires, Argentina. dipm1967@gmail.com
Insights
A new pediatric surgical risk scale (ERQ) effectively predicts severe postoperative complications, outperforming the standard anesthetic risk (ASA) score. This tool aids in quantifying surgical risk and improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Risk Assessment
- Postoperative Complications
Context:
- Accurate surgical risk assessment is crucial for managing postoperative complications and hospital resources.
- Developing a pediatric-specific surgical risk scale (ERQ) requires easily obtainable variables for consistent application.
- Previous methods lacked a standardized, pediatric-focused approach to surgical risk stratification.
Purpose:
- To construct and validate a surgical risk scale (ERQ) for pediatric surgery.
- To analyze the relationship between surgical risk and postoperative outcomes.
- To compare the predictive power of the ERQ with the anesthetic risk (ASA) score for severe complications.
Summary:
- A retrospective analysis of 105 pediatric surgical procedures was conducted.
- The ERQ was developed using patient risk factors (weight, comorbidities, life support) and surgical procedure magnitude (time, blood transfusion needs).
- The ERQ demonstrated a high predictive power (0.87) for severe postoperative complications (STROC ≥ 3), surpassing the ASA score (0.81).
Impact:
- The ERQ provides a simple, effective tool for quantifying and comparing surgical risks and outcomes in pediatric patients.
- Its high predictive accuracy can lead to better preoperative planning and resource allocation.
- The ERQ facilitates improved patient safety and management of severe postoperative complications.
Introduction:
The need to measure the level of surgical risk arises from its direct relationship with the development of postoperative complications and the use of hospital resources. The construction of a surgical risk scale (ERQ) for pediatric surgery should be based on a common language, by using a small number of easy to collect and reproduce variables. The objectives of this study were to construct an ERQ for pediatric patients and to analyze the surgical performance.
Materials And Methods:
We retrospectively analyzed 105 primary surgical procedures under general anesthesia performed by liver transplantation service at Hospital Garrahan, between 29/6/08 and 25/3/10. Newborn patients were not considered. The ERQ was built by adding patient risk factors (PRL): weight (< o > 10 kg), co-morbidities (coagulopathy-obesity-diabetes) and life support; and the magnitude level of the surgical procedure (SPL): surgical time and requirement of blood transfusions. The surgical performance was considered as a relation between the level of surgical risk and the post-operative results, measured with the classification of surgical complications proposed by Clavien et al (STROC). The main end point of the study was the STROC > or = 3 (severe complications). The ERQ predictive power for serious complications was compared with the anaesthetic risk (ASA). Descriptive and analytical statistics took place. The predictive value for complications was calculated by means of a ROC curve. The estimation of the risk was calculated by relative risk.
Results:
The ERQ was constituted on a continuum of 6 risk levels (2 to 7). The ROC's curve predictive power to determine the development of severe post-operative complications (STROC > or = 3) was 0.87 (CI 0,80-0,94) for the ERQ and 0.81 (CI 0,73-0,89) for the ASA. Level of > or = 5 of ERQ was the cut-off point that better predicted the development of STROC > or = 3.
Conclusion:
The ERQ is an easy tool, useful to quantify and compare surgical risks and results. It showed a high predictive power of postoperative complications.
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