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Published on: November 20, 2015
Variation in Complications and Mortality According to Infant Diagnosis
Steven C Mehl1,2, Jorge I Portuondo1, Sara C Fallon1
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Insights
Infant perioperative mortality is linked to specific diagnoses and complications. Cardiovascular, renal, and central nervous system complications significantly increase mortality risk in infants undergoing surgery.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Infant Health
Background:
- Infant mortality is a significant concern in pediatric surgery.
- Limited data exists on infant perioperative mortality patterns and high-burden diagnoses.
Purpose of the Study:
- Investigate infant perioperative mortality patterns.
- Identify infant diagnoses with the highest mortality burden.
- Evaluate the association between postoperative complications and mortality.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program-Pediatric database (2012-2019).
- Stratification of perioperative mortality into complication-associated and non-associated.
- Categorization of complications (wound, systemic infection, pulmonary, CNS, renal, cardiovascular).
- Multivariable logistic regression to assess complication-mortality association.
Main Results:
- 1.6% perioperative mortality in 111,946 infants; 38.8% of deaths were complication-associated.
- Seven diagnoses (necrotizing enterocolitis, congenital diaphragmatic hernia, etc.) accounted for 40.3% of mortality.
- Cardiovascular (OR: 19.4), renal (OR: 6.88), and CNS (OR: 6.50) complications had the highest odds of mortality.
Conclusions:
- A small group of diagnoses drives a significant portion of infant surgical mortality.
- Specific postoperative complications are strongly associated with increased mortality risk.
- Targeted quality improvement initiatives are recommended to reduce adverse infant surgical outcomes.
Objective:
Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants.
Background:
The majority of mortality events in pediatric surgery occur among infants (ie, children <1 y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality.
Methods:
Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012-2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality.
Results:
Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9-27.0], renal (OR: 6.88; 4.65-10.2), and central nervous system complications (OR: 6.50; 4.50-9.40) had the highest odds of mortality for all infants.
Conclusions:
A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.
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