A novel risk classification system for 30-day mortality in children undergoing surgery

<div><p>A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.</p></div

Fryns syndrome in children with congenital diaphragmatic hernia

Fryns syndrome is characterized by multiple congenital anomalies including Congenital Diaphragmatic Hernia (CDH), and has a reported poor prognosis with a survival rate during the neonatal period of approximately 15%. This report details the management and outcome of patients with Fryns syndrome and CDH. Records of all liveborn patients with CDH between 1995 and 2001 in 83 hospitals were entered into the CDH database. Those with Fryns syndrome were reviewed retrospectively. A total of 1,833 patients were entered in the database, 23 of these had Fryns (1.3%). All patients experienced early distress requiring intubation. Ten patients (43%) were found to have other major anomalies. Seven patients underwent surgical repair at an average age of 7.5 days (range, 6 hours to 14 days). Mortality rate was 83% compared with 33% of patients with unilateral CDH (P =.01). Ten patients died within the first 24 hours. The parents of 6 patients withdrew support. Of the 4 survivors, 3 have marked developmental delay, whereas the fourth has not yet undergone formal assessment. The prognosis of infants with Fryns syndrome and congenital diaphragmatic hernia remains grim. Early genetic counseling and recognition of lethal anomalies may assist in determining which patients may survive

Preoperative therapy and risk for death after surgery.

<p>Preoperative therapy and risk for death after surgery.</p

Parsimonious LR model built on variables selected by classification tree analysis.

<p>Parsimonious LR model built on variables selected by classification tree analysis.</p

Comorbidities and risk for death after surgery.

<p>Comorbidities and risk for death after surgery.</p

Surgical mortality risk groups for children.

<p>Surgical mortality risk groups for children.</p

Patient characteristics and risk for death after surgery.

<p>Patient characteristics and risk for death after surgery.</p

Observed mortality by risk group for sub groups.

<p>The observed mortality is plotted logarithmically by group. A = Very Low, B = Moderately Low, C = Moderately High, D = High, E = Very High. Each bar represents the estimate of the risk and confidence interval. The arrow is the observed rate for all patients from 2012–2015.</p