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Perioperative hospital mortality at a tertiary paediatric institution
L de Bruin1, W Pasma2, D B M van der Werff2
1Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands Present affiliation: Department of Surgery, Amstelland Hospital, Amstelveen, The Netherlands.
Insights
Postoperative mortality is low in children, with few deaths directly linked to anesthesia or surgery. Higher risks are seen in neonates, infants, and those undergoing emergency or cardiothoracic procedures.
Area of Science:
- Pediatric Anesthesiology
- Perioperative Medicine
- Pediatric Surgery Outcomes
Background:
- Limited research exists on pediatric postoperative mortality.
- Understanding causes of death can improve perioperative care.
- This study addresses the scarcity of data on pediatric mortality.
Purpose of the Study:
- To report 24-hour and 30-day in-hospital mortality rates.
- To analyze overall, surgery-related, and anesthesia-related mortality.
- To identify risk factors for mortality in pediatric patients.
Main Methods:
- Retrospective cohort study of patients under 18 years old.
- Data collected from January 2006 to December 2012.
- Causes of death were identified and categorized.
Main Results:
- 45,182 anesthetics administered over 7 years.
- 24-hour mortality: 13.1/10,000; 30-day mortality: 41.6/10,000.
- Anesthesia-related mortality: 1.1/10,000; Surgery-related mortality: 0.9/10,000.
Conclusions:
- Mortality is higher in neonates, infants, and those with ASA status III/IV.
- Emergency and cardiothoracic surgery patients face increased risk.
- Anesthesia and surgery complications contribute minimally to overall mortality, indicating safety.
Background:
Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital.
Methods:
All patients <18 yr old who underwent anaesthesia with or without surgery between January 1, 2006, and December 31, 2012, at the Wilhelmina Children's Hospital, Utrecht, The Netherlands, were included in this retrospective cohort study. Causes of death within 30 days were identified and tabulated into four major categories according to principal cause.
Results:
A total of 45,182 anaesthetics were administered during this 7-yr period. The all-cause 24-hour hospital mortality was 13.1 per 10,000 anaesthetics (95% CI: 9.9-16.8) and the all-cause 30-day in-hospital mortality was 41.6 per 10,000 anaesthetics (95% CI: 35.9-48.0). In total five patients were partially contributable to anaesthesia (30-day mortality: 1.1/10,000, 95% CI: 0.4-2.6) and four patients were partially contributable to surgery (30-day mortality: 0.9/10,000, 95% CI: 0.2-2.3). Mortality was higher in neonates and infants, children with ASA physical status III and IV, and emergency- and cardiothoracic surgery.
Conclusions:
Neonates and infants, children with ASA physical status III or poorer, and emergency- and cardiothoracic surgery are associated with a higher postoperative mortality. Anaesthesia- or surgery-related complications contribute to mortality in only a small amount of the deaths, indicating the relative safety of paediatric surgical and anaesthetic procedures.
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