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Pediatric preoperative risk factors to predict postoperative ICU admission and death from a multicenter retrospective
Chunwei Lian1, Zuokai Xie1, Zhao Wang1
1Department of Anesthesiology, Critical Care and Pain Medicine, The 2nd Affiliated Hospital & Yuying Children's Hospital of WenZhou Medical University, Wenzhou, China.
Insights
Pediatric surgical patients
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Limited research exists on predictors of perioperative mortality specifically in pediatric populations.
- Understanding these factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify preoperative risk factors for pediatric surgical patients.
- To develop a pediatric preoperative risk prediction score (PRPS).
- To predict postoperative intensive care unit (ICU) admission and perioperative death.
Main Methods:
- Retrospective analysis of 263,607 pediatric surgical patients (1 day to 14 years) across eight Chinese centers (Oct 2010-Sep 2013).
- Comparison between 1812 patients with ICU admission or death and 5500 randomly selected controls.
- Logistic regression and ROC curve analysis to identify independent predictors and assess model performance.
Main Results:
- Data from 6626 patients were analyzed after exclusions.
- Independent predictors for critical outcomes included age, American Society of Anesthesiologists (ASA) physical status, SpO2, prematurity, and unfasted status.
- The developed risk model demonstrated excellent predictive performance with an AUC of 0.905.
Conclusions:
- Age, ASA physical status, SpO2, prematurity, and unfasted status are significant risk factors for predicting postoperative ICU admission and death in pediatric patients.
- These findings can inform risk stratification and management strategies in pediatric surgery.
Background:
Although some studies have investigated the potential predictors of perioperative mortality, there are few specifically for pediatrics.
Objective:
The aim of the retrospective study was to analyze potential preoperative risk factors and to develop a pediatric preoperative risk prediction score (PRPS), and to predict postoperative ICU admission and the incidence of perioperative death in pediatric patients.
Methods:
Patients who postoperatively admitted to ICU or died (occurred within 30 days after the surgery) from 263 607 pediatric surgical patients with age from 1 day to 14 years old in eight centers in China from October 2010 to September 2013 were retrospectively analyzed. About 5500 non-ICU admission and death patients were randomly selected from those 263 607 patients as controls for analysis comparison. Independent risk factors and a risk model were derived from these analyses, and were further assessed with the likelihood ratio test and the area under the receiver operating characteristic (ROC) curve.
Results:
There were 1812 ICU admission or death patients but 187 patients' records are incomplete. There were 487 patients with incomplete records among 5500 controls. Collectively, data from 6626 patients were enrolled in final analyses. With multiple logistic regression analysis, age, ASA physical status, SpO2 , prematurity, and unfasted status were found to be independent predictors for critical patients. The AUC value of 0.905 indicated excellent predictive performance between critical and noncritical predictors.
Conclusions:
Our study revealed that age, ASA physical status, SpO2 , prematurity, and unfasted status are risk factors to predict postoperative ICU admission and death in pediatric patients.
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