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Major morbidity and mortality associated with delays to emergent surgery in children: a risk-adjusted analysis
Sonia Anne Butterworth1, Irena Zivkovic2, Sandra Kim2
1From the Division of Pediatric Surgery, University of British Columbia, Vancouver, BC (Butterworth); BC Children's Hospital, Vancouver, BC (Butterworth); the Faculty of Medicine, University of British Columbia, Vancouver, BC (Zivkovic); the Department of Urology, Dalhousie University, Halifax, NS; and the Department of Urology, University of British Columbia, BC Children's Hospital, Vancouver, BC (Afshar) sbutterworth@cw.bc.ca.
Insights
Delays in emergency pediatric surgery significantly increase the risk of major morbidity and mortality. Prioritizing these urgent surgical cases is crucial to prevent adverse outcomes in children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Patient Safety
Background:
- Emergency surgery delays contribute to patient morbidity and mortality.
- Physiologic status critically impacts outcomes for emergent surgery patients.
Purpose of the Study:
- To determine if delays in emergent pediatric surgery correlate with increased major morbidity or mortality.
- To assess outcomes in a risk-adjusted pediatric population.
Main Methods:
- Retrospective review of 384 pediatric surgical procedures (2011-2016).
- Data included American Society of Anesthesiologists classification, SNAP II, and PRISM III scores.
- Delay defined as >60 minutes from booking to operating room; major morbidity as unintended organ/limb/function loss.
Main Results:
- 47.9% of cases were delayed; 24.5% experienced major morbidity, and 7.6% died (all high-risk).
- Delayed surgery was linked to increased mean time to the operating room (1.46 vs. 1.17 hours).
- Multivariate analysis revealed an 85% increased odds of morbidity/mortality with delays (aOR 1.85).
Conclusions:
- Delay to emergent pediatric surgery significantly increases major morbidity and/or mortality.
- Urgent surgical care requires prioritization by hospital systems and government to mitigate negative consequences.
- Ensuring timely access to emergency surgery is vital for improving pediatric patient outcomes.
Background:
Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population.
Methods:
We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children's Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ2 test for univariate analysis and logistic regression for multivariate analysis.
Results:
There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d-18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20-2.94) compared to no delay.
Conclusion:
Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.
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