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Association between index complication and outcomes after inpatient pediatric surgery
Jorge I Portuondo1, Steven C Mehl2, Sohail R Shah2
1Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX, United States; Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Suite 404D, Houston, TX 77030, United States.
Insights
Different initial surgical complications significantly impact pediatric patient outcomes, including secondary issues and failure to rescue (death). Infectious complications increase secondary issues, while cardiovascular complications are most linked to failure to rescue.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Patient Safety
Background:
- Failure to rescue (FTR) is often attributed to a cascade of postoperative complications.
- The specific impact of index complication types on secondary complications and FTR in pediatric surgery remains unclear.
Purpose of the Study:
- To investigate the association between specific index complication types and the incidence of secondary complications and FTR in pediatric surgical patients.
- To identify which initial complications pose the greatest risk for adverse outcomes.
Main Methods:
- A national cohort study utilizing the National Surgical Quality Improvement Program-Pediatric database (2012-2019).
- Index complications were categorized into nine groups (e.g., cardiovascular, infectious, wound).
- Multivariable logistic regression and generalized linear modeling were used to assess associations with FTR, secondary complications, reoperation, readmission, and length of stay.
Main Results:
- Among 425,386 patients, 15.5% experienced complications, with FTR occurring in 2.4%.
- Infectious complications showed the highest likelihood of leading to secondary complications (OR 10.3).
- Cardiovascular complications were most strongly associated with FTR (OR 30.7), wound complications with reoperation/readmission, and pulmonary complications with length of stay.
Conclusions:
- The type of index complication significantly influences subsequent perioperative outcomes in pediatric surgery.
- Identifying high-risk complication types can aid in predicting patients susceptible to adverse events.
- These findings can guide targeted pediatric quality improvement initiatives.
Purpose:
A cascade of complications is believed to be the primary mechanism underlying failure to rescue (FTR), or death of a patient after a postoperative complication. It is unknown whether specific types of index complications are associated with the incidence of secondary complications and FTR after pediatric surgery.
Methods:
National cohort study of patients within the National Surgical Quality Improvement Program-Pediatric database who underwent inpatient surgery (2012-2019). Index complications were grouped into nine categories (cardiovascular, venous thromboembolism, pulmonary, bleeding/transfusion, renal, central nervous system, wound, infectious, or minor [defined as having an associated mortality rate <1%]). The association between the type of index complication with FTR, secondary complications, reoperation, unplanned readmission, and postoperative length of stay was evaluated with multivariable logistic regression and generalized linear modeling.
Results:
Among 425,386 patients, 15.5% had at least one complication, 16.6% had one or more secondary complications, 13.9% reoperation, 14.5% readmission, and 2.4% FTR. Secondary complication (10.8-59.7%) and FTR (0.3-31.1%) rates varied by type of index complication. Relative to patients who had an index minor complication, those with an index infectious complication were most likely to have secondary complication (Odds Ratio [OR] 10.3, 95% CI [9.36-11.4]). Index CV complications were most strongly associated with FTR (OR 30.7 [24.0-39.4]). Index wound complications had the greatest association with reoperation (OR 21.9 [20.5-23.4]) and readmission (OR 18.7 [17.6-19.9]). Index pulmonary complications had the strongest association with length of stay (coefficient 9.39 [8.95-9.83]).
Conclusions:
Different types of index complications are associated with different perioperative outcomes. These data can help identify patients potentially at risk for suboptimal outcomes and can inform pediatric quality improvement interventions.
Type Of Study:
Cohort study.
Level Of Evidence:
Level II.
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