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Published on: October 23, 2020
Prognostic profiling of children with serious post-operative complications: A novel probability model for failure to
Christian Mpody1, Jordan Arends1, Jennifer H Aldrink2
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
Insights
A new pediatric risk index identifies children likely to die after surgery due to complications. High-risk children with many comorbidities face a significantly higher failure to rescue (FTR) rate, enabling targeted interventions.
Area of Science:
- Pediatric surgery
- Surgical quality metrics
- Patient risk stratification
Background:
- Failure to rescue (FTR), defined as mortality after a major postoperative complication, is a critical surgical quality metric.
- Existing metrics like mortality or complication rates alone do not adequately identify high-risk pediatric surgical patients.
- There is a need for a novel pediatric profiling system to identify children at high risk for FTR.
Purpose of the Study:
- To develop and validate a novel pediatric profiling system.
- To identify high-risk pediatric surgical patients who develop serious postoperative complications.
- To evaluate the rate of FTR based on pre-operative comorbidity burden.
Main Methods:
- Retrospective study of pediatric inpatient surgeries with major postoperative complications (2012-2017) from NSQIP-Pediatric hospitals.
- Analysis of Failure to Rescue (FTR) rates in relation to pre-operative comorbidity burden.
- Development of a prognostic index to stratify risk.
Main Results:
- 45,504 surgical cases with major postoperative complications were identified, with an overall FTR rate of 2.4%.
- Cases with >6 pre-operative comorbidities (28% of cases) accounted for 80% of FTR events.
- FTR probability was 0.1% (low-risk), 3.3% (intermediate-risk), and 22.6% (high-risk). High-risk patients had a 22.6% mortality rate, with half dying within 48 hours.
Conclusions:
- A prognostic index was developed to accurately identify pediatric patients at risk for Failure to Rescue (FTR).
- This index can help surgeons identify high-risk children needing aggressive monitoring and therapeutic strategies.
- Implementation of this index has the potential to reduce pediatric surgical mortality.
Background:
Failure to rescue (FTR), mortality after a major postoperative complication, is a superior surgical quality metric compared to surgical mortality or complications rates alone. Our objective was to develop and validate a novel pediatric profiling to identify high-risk subjects among the subset of children who develop serious post-operative complications.
Methods:
We performed a retrospective study of children who developed one or more serious postoperative complications following inpatient surgery across NSQIP-Pediatric hospitals (2012-2017). We evaluated the rate of FTR according to pre-operative comorbidity burden.
Results:
We identified 45,504 surgical cases with major post-operative complications (FTR rates: 2.4%). Surgical cases with greater than six pre-operative comorbidities (n = 12,148;28%) accounted for 80% of FTR events. The expected probability of FTR was 0.1%(95%CI:0.1%-0.2%) among low-risk cases, 3.3%(95%CI:3.0%-3.5%) among intermediate-risk cases, and 22.6%(95%CI:20.9%-24.3%) among high-risk cases. About half of surgical cases in the high-risk profile group died within 48 h of surgery. Comparatively, cases in the intermediate-risk group had a much longer time to mortality (10 days).
Conclusion:
We propose a prognostic index to accurately identify children at risk for FTR. The use of such an index may provide surgeons with a window of opportunity to implement aggressive monitoring and therapeutic strategies to reduce mortality.
Level Of Evidence:
IV.
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