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Validation of the pediatric surgical risk assessment scoring system
Guilherme Wood1, Ghassan Barayan, Daniela C J Sanchez
1Department of Urology, Robotic Surgery, Research and Training Center and the Boston Children's Hospital, Boston, MA, USA; Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
Insights
We validated two scoring systems, the Preoperative Complication Score (PCS) and Overall Complication Score (OCS), to predict major complications and death in pediatric surgical patients. Both scores effectively identified at-risk children, aiding in surgical risk assessment.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Risk Stratification
Background:
- Validated risk stratification tools for adult postoperative outcomes are abundant, but scarce for pediatric populations.
- A previously developed scoring system aimed to predict postoperative complications in children undergoing surgery.
- This study sought to validate the previously developed scoring system in a pediatric surgical cohort.
Purpose of the Study:
- To validate a previously developed scoring system for predicting postoperative complications in children.
- To determine the effectiveness of the scoring system in identifying pediatric patients at risk for major complications or death within 30 days post-surgery.
Main Methods:
- A random sample of 2015 pediatric patients from 11,734 surgeries in 2009 was analyzed.
- Complication severity was graded using the Clavien classification system (Grade III or higher for major complications).
- Preoperative Complication Score (PCS) and Overall Complication Score (OCS) were calculated; Receiver Operating Characteristic (ROC) curves were generated.
Main Results:
- The overall incidence of major complications was 3.9% (79 patients).
- Cardiac surgery exhibited the highest complication rate (20% of surgeries).
- Both PCS and OCS showed excellent predictive ability with c-statistics of 0.740 and 0.767, respectively (p < 0.001).
Conclusions:
- The PCS and OCS are effective tools for identifying children at risk of major complications and death after surgery.
- Further research is needed to assess applicability across institutions and impact on clinical outcomes and costs.
Background:
Within the adult population, there exist numerous validated risk stratification tools aimed at predicting postoperative outcomes using preoperative and intraoperative parameters. However, similar tools for the pediatric population are scarce. We previously developed and reported on a scoring system to predict postoperative complications in children undergoing surgery at Boston Children's Hospital. The objective of this study was to validate our scoring system to determine its effectiveness in identifying children at risk for major complications or death within 30 days following surgery.
Study Design:
A computer program randomly selected 2015 out of 11,734 patients who underwent surgery at our institution in 2009. The severity of the complications was graded based on the Clavien classification system, with major complications being a grade III or higher. The Preoperative Complication Score (PCS) and the Overall Complication Score (OCS) were calculated for all patients, and Receiver Operating Characteristic (ROC) curves were generated for each scoring system.
Results:
The overall incidence of major complications was 3.9% (79 patients). Proportionally, cardiac surgery had the highest percentage of major complications (20% of the performed surgeries). Both PCS and OCS demonstrated excellent correlation with postoperative outcomes with c-statistic values of 0.740 (CI 0.682-0.800, p < 0.001) and 0.767 (CI 0.712-0.822, p < 0.001) respectively.
Conclusions:
We determined that both the PCS and OCS are effective in identifying children at risk for major complications and death following surgery. Further studies will be needed to determine if these scoring systems are applicable to children undergoing surgery at other institutions and if the use of the scoring systems would result in improved clinical outcomes and reduced costs.
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