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Puri S, Sen IM, Bhardwaj N, Yaddanapudi S, Mathew PJ, Bandyopadhyay A, Samujh R, Dogra S, Kumar P. Postoperative outcome of neonatal emergency surgeries in a tertiary care institute-A prospective observational study. Paediatr Anaesth 2023; 33:1075-1082. [PMID: 37483171 DOI: 10.1111/pan.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
AIMS Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. METHODS This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. RESULTS Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty-two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea-esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in-hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non-invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. CONCLUSION Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6-week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjishnujit Bandyopadhyay
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivani Dogra
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Julien-Marsollier F, Cholet C, Coeffic A, Dupont T, Gauthier T, Loiselle M, Brouns K, Bonnard A, Biran V, Brasher C, Dahmani S. Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis. Paediatr Anaesth 2022; 32:421-428. [PMID: 34984774 DOI: 10.1111/pan.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis. MATERIAL AND METHODS The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics. RESULTS The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications. CONCLUSION Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Clementine Cholet
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Adrien Coeffic
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Dupont
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Gauthier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of general and urological surgery, Robert Debré University Hospital, Paris, France
| | - Valerie Biran
- Université de Paris, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.,Department of Neonatology, Robert Debré University Hospital, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Integrated Critical Care, University of Melbourne, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
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3
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Deguchi K, Tazuke Y, Matsuura R, Nomura M, Yamanaka H, Soh H, Yoneda A. Factors Associated With Adverse Outcomes Following Duodenal Atresia Surgery in Neonates: A Retrospective Study. Cureus 2022; 14:e22349. [PMID: 35371797 PMCID: PMC8936229 DOI: 10.7759/cureus.22349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives There is limited evidence on the infants' postoperative complications who have undergone surgical repair of duodenal atresia and stenosis. This study aimed to identify the factors associated with poor surgical outcomes after the initial repair. Methods We retrospectively reviewed the data of 82 patients who underwent surgery for duodenal atresia and stenosis between January 1994 and December 2013 at our institution. Gestational age, birth weight, fetal growth, and other associated anomalies were recorded. Multivariate regression analyses were used to identify the factors associated with surgical outcomes, including postoperative complications and time to full oral intake. Results The median gestational age was 37.6 weeks, with 30 (37%) preterm (<37 weeks) and 11 (13%) early preterm (<34 weeks) infants. The median birth weight was 2531 g, with 27 (33%) patients < 2000 g and 10 (12%) patients < 1500 g. Postoperative surgical complications were identified in 18 (22%) cases, of which 12 (15%) required additional operations. Multivariate regression analysis revealed that a combination of very low birth weight (<1500 g) and early preterm was significantly associated with both surgical and non-surgical postoperative complications (p = 0.0028 and 0.021, respectively) and a prolonged time to full oral intake postoperatively (p = 0.013). Conclusion Very low birth weight and early preterm were significantly associated with postoperative complications and a prolonged time to full oral intake.
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Srinivasan N, Mahajan J, Gupta S, Shah YM, Shafei J, Levidy MF, Abdelmalek G, Pant K, Jain K, Zhao C, Chu A, McGrath A. Surgical timing in neonatal brachial plexus palsy: A PRISMA-IPD systematic review. Microsurgery 2022; 42:381-390. [PMID: 35147253 PMCID: PMC9305151 DOI: 10.1002/micr.30871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/23/2021] [Accepted: 01/28/2022] [Indexed: 12/05/2022]
Abstract
Background Neonatal brachial plexus palsy (NBPP) is a serious complication of high‐risk deliveries with controversy surrounding timing of corrective nerve surgery. This review systematically examines the existing literature and investigates correlations between age at time of upper trunk brachial plexus microsurgery and surgical outcomes. Methods A systematic screening of PubMed, Cochrane, Web of Science, and CINAHL databases using PRISMA‐IPD guidelines was conducted in January 2020 to include full‐text English papers with microsurgery in upper trunk palsy, pediatric patients. Spearman rank correlation analysis and two‐tailed t‐tests were performed using individual patient data to determine the relationship between mean age at time of surgery and outcome as determined by the Mallet, Medical Research Council (MRC), or Active Movement Scale (AMS) subscores. Results Two thousand nine hundred thirty six papers were screened to finalize 25 papers containing individual patient data (n = 256) with low to moderate risk of bias, as assessed by the ROBINS‐I assessment tool. Mallet subscore for hand‐to‐mouth and shoulder abduction, AMS subscore for elbow flexion and external rotation, and MRC subscore for elbow flexion were analyzed alongside the respective age of patients at surgery. Spearman rank correlation analysis revealed a significant negative correlation (ρ = −0.30, p < .01, n = 89) between increasing age (5.50 ± 2.09 months) and Mallet subscore for hand‐to‐mouth (3.43 ± 0.83). T‐tests revealed a significant decrease in Mallet hand‐to‐mouth subscores after 6 months (p < .05) and 9 months (p < .05) of age. No significant effects were observed for Mallet shoulder abduction, MRC elbow flexion, or AMS elbow flexion and external rotation. Conclusion The cumulative evidence suggests a significant negative correlation between age at microsurgery and Mallet subscores for hand‐to‐mouth. However, a similar correlation with age at surgery was not observed for Mallet shoulder abduction, MRC elbow flexion, AMS external rotation, and AMS elbow flexion subscores.
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Affiliation(s)
- Nivetha Srinivasan
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Jasmine Mahajan
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Shivani Gupta
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Yash M Shah
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Jasmine Shafei
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Michael F Levidy
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - George Abdelmalek
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Krittika Pant
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Kunj Jain
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Caixia Zhao
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Alice Chu
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Aleksandra McGrath
- Department of Clinical Sciences, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Zoeller C, Kuebler JF, Ure BM, Brendel J. Incidence of complications, organizational problems, and errors: Unexpected events in 1605 patients. J Pediatr Surg 2021; 56:1723-1727. [PMID: 33353740 DOI: 10.1016/j.jpedsurg.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Besides surgical complications, a variety of adverse events may affect patients' comfort and outcome. The purpose of this prospective study was to identify the incidence and impact of all unexpected events in pediatric surgical patients. METHODS All unexpected events that occurred in our department during the period of February 2017-July 2018 were prospectively assessed. Complications associated with surgery, non-surgical treatment, errors and organizational problems were included. Events were classified using a modified version of Clavien-Dindo. Sentinel events were defined as death, serious injury, or the risk thereof (grade IV-V). Organizational events were analyzed separately. All events were discussed during morbidity and mortality-conferences, and the results and measures were documented. RESULTS Unexpected events occurred in 297 of 1605 patients (18.5%), of whom 1124 (70%) had undergone surgery. More than half of all events were not associated with an operation (n=237; 54%). The severity of all events was mostly minor (grade I-IIIb; n=410; 94%). Twenty-eight sentinel events (IV-V) occurred (6% of all events). Twenty-two (2%) patients died; however, none of these deaths were related to surgery. The top 5 events included organizational problems in 78 instants (18%), wound healing disorders in 44 (10%), recurrence of initial problems in 36 (8%), dislocation of indwelling catheters in 26 (6%) and bleeding in 16 (4%). Errors were identified in 15 patients (3%). We derived 10 changes of concepts of management or treatment. CONCLUSION The incidence of unexpected events in pediatric surgical patients is high when complications associated with surgical and non-surgical treatment and organizational alterations are documented prospectively. In our study, most events were minor and did not substantially affect patients' outcomes. Prospective assessment helped to identify organizational shortcomings and develop preventive strategies.
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Affiliation(s)
- Christoph Zoeller
- Hannover Medical School, Department of Pediatric Surgery, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Joachim F Kuebler
- Hannover Medical School, Department of Pediatric Surgery, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Benno M Ure
- Hannover Medical School, Department of Pediatric Surgery, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Julia Brendel
- Hannover Medical School, Department of Pediatric Surgery, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Skertich NJ, Ingram MCE, Ritz E, Shah AN, Raval MV. The influence of prematurity on neonatal surgical morbidity and mortality. J Pediatr Surg 2020; 55:2608-2613. [PMID: 32498947 DOI: 10.1016/j.jpedsurg.2020.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND As survival rates amongst premature infants have improved, prematurity remains a leading contributor to neonatal surgical morbidity and mortality. This study aims to better assess the influence of prematurity on surgical outcomes. METHODS The NSQIP-Pediatric database was used to compare outcomes between preterm and term infants undergoing surgical repair of select congenital anomalies from 2012 to 2017. Prematurity was categorized as extremely preterm (EP) (<29 weeks), very preterm (VP) (29-32 weeks), moderate to late preterm (MLP) (33-36 weeks), and term (≥37 weeks). Significance was determined using Chi-square tests, Fisher exact tests and adjusted logistic regression analysis. RESULTS 4852 infants were identified with 45 (0.9%) EP, 211 (4.3%) VP, 1492 (30.8%) MLP, and 3104 (64.0%) term. Compared to term, preterm infants have increased odds of surgical morbidity (EP Odds Ratio (OR) 3.2 95% Confidence Interval (CI) 1.6-6.4, VP OR 1.2 95%CI 0.9-1.7, and MLP OR 1.2 95%CI 1.0-1.4). 30-day mortality decreased as neonatal age increased from 22.2% EP to 2.9% term (p < 0.001). Premature populations had higher rates of sepsis, pneumonia, bleeding requiring transfusion and 30-day mortality. CONCLUSIONS Prematurity increases morbidity and mortality amongst neonates undergoing surgery. Risk-adjustment for prematurity is needed and premature infants may have unique quality improvement targets. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nicholas J Skertich
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Martha-Conley E Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Ethan Ritz
- Rush Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.
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7
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Risk factors of early mortality after neonatal surgery in Tunisia. J Pediatr Surg 2020; 55:2233-2237. [PMID: 32654833 DOI: 10.1016/j.jpedsurg.2020.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research concerning factors of death after neonatal surgery is scarce. Insight into mortality might improve perioperative care. This study aimed to identify predictive factors of mortality after neonatal surgery in a low income country (LIC). METHODS Charts of all newborn patients who underwent surgical procedures under general anesthesia during the neonatal period in our department of pediatric surgery between January 2010 and December 2017 were reviewed. We used univariate and multivariate analysis to evaluate perioperative variables potentially predictive of early postoperative mortality. RESULTS One hundred eighty-two cases were included in the study: 41 newborns (28.6%) were premature (<37 weeks of gestation) and 52 (22.5%) weighed less than 2.5 kg. The most commonly diagnosed conditions were esophageal atresia (24%) and bowel obstruction (19%). Forty-four patients (24%) died during hospitalization. The highest rate of mortality was observed for congenital diaphragmatic hernia. Univariate analysis showed that perinatal predictive variables of mortality were prematurity, low birth weight, the necessity of preoperative intubation, and duration of surgery more than 2 h. Logistic regression showed three independent risk factors, which are the duration of surgery, low birth weight and the necessity of preoperative intubation. CONCLUSION The overall mortality in infants undergoing neonatal surgery is still high in LICs. Knowledge of independent risk factors of early mortality may help clinicians to more adequately manage the high-risk population. TYPE OF THE STUDY Clinical research paper. LEVEL OF EVIDENCE III.
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Long JB, Fiedorek MC, Oraedu O, Austin TM. Neonatal intensive care unit patients recovering in the post anesthesia care unit: An observational analysis of postextubation complications. Paediatr Anaesth 2019; 29:1186-1193. [PMID: 31587412 DOI: 10.1111/pan.13750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal patients are at higher risk in the perioperative period than older infants and children. Extubation as an early goal for noenatal intensive care unit patients presenting for surgery is undergoing a renaissance period, and an exploration of adverse events following selection for extubation immediately after general anesthesia has not specifically been undertaken in this population. AIMS The objective of this study is to determine the adverse events most commonly encountered in neonatal intensive care unit patients recovering from anesthesia in the post anesthesia care unit, quantify the risk of event occurrence, and identify risk factors that may increase the risk of postoperative adverse events. METHODS All neonatal intensive care unit patients presenting to the operating room 6/1/2014-5/31/2018 who recovered in the post anesthesia care unit were included for analysis. Univariate analyses were conducted utilizing the Wilcoxon rank-sum test or Fisher exact test. Due to the low event rate, a small-sample generalized estimating equation model was created with a major event composite as the outcome and explanatory variables with P values < .1 on univariate analysis. Statistically significant continuous variables were then dichotomized based on Youden index. RESULTS There were 707 operative cases in 607 patients. There were 81 total events recorded, and 64/81 were considered to be major events; all of which were respiratory. The risk of any postoperative event was 11.5%, major respiratory event requiring intervention by a nurse or provider was 9.1%, and reintubation was 0.8%. Birth weight < 1.58 kg (OR 3.71; 95% CI 2.11-6.53; P < .001) and postmenstrual age at surgery <41 weeks (OR 3.20; 95% CI 1.54-6.63; P < .001) were strongly associated with an increased risk of a major postoperative respiratory event. CONCLUSION The most important factors associated with major events in the post anesthesia care unit following extubation of neonatal intensive care unit patients were birth weight < 1.58 kg and postmenstrual age at surgery < 41 weeks. A patient with both features has a 7-fold increase in the odds of a major respiratory event in the post anesthesia care unit. Careful consideration of the postoperative ventilation and monitoring strategy must be given to patients with low birth weight (<1.58 kg) or who are <41 weeks postmenstrual age at the time of surgery.
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Affiliation(s)
- Justin B Long
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael C Fiedorek
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - O'Dez Oraedu
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Thomas M Austin
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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Talini C, Antunes LA, Carvalho BCND, Schultz KL, Del Valle MHCP, Aranha Junior AA, Cosenza WRT, Amarante ACM, Silveira AED. Circumcision: postoperative complications that required reoperation. ACTA ACUST UNITED AC 2018; 16:eAO4241. [PMID: 30110068 PMCID: PMC6080702 DOI: 10.1590/s1679-45082018ao4241] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients’ age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients’ age did not influence in complications.
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10
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Sethi MVA, Zimmer J, Ure B, Lacher M. Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery. J Pediatr Surg 2016; 51:630-3. [PMID: 26628204 DOI: 10.1016/j.jpedsurg.2015.10.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 12/31/2022]
Abstract
AIMS OF THE STUDY We aimed to assess postoperative complications prospectively on a daily basis and hypothesized that this would lead to an increase in the number of detected complications. METHODS Surgical complications were assessed prospectively during a period of 8months. Systematic documentation was carried out daily during a team meeting (period S). Data were compared to those of a preceding period of 8-months of nonsystematic assessment (period N) in which complications had been documented in a self-reporting fashion. Complications were classified according to the Clavien-Dindo classification. RESULTS A total of 1291 patients (mean age: 6.6years) were included. During period S complications were determined in 16% of 790 operations compared to 4% of 741 procedures in period N (p<0.01). This difference was owing to an increased detection of minor complications (grade I-III), i.e. wound infection, dysuria after hypospadias repair or postoperative bleeding. In contrast, the incidence of severe complications (grade IV+V) was not significantly different between the time periods (1.3% in period S and 0.8% in period N). Most frequent major complications were cardiopulmonary arrest, enterocolitis, and death. Severe complications accounted for 8% of complications discussed during weekly morbidity and mortality conferences in period S versus 22% in period N (p<0.05). CONCLUSION Our results indicate that a systematic documentation of complications on a daily basis reveals a more realistic picture of the incidence of pediatric surgical complications and should be the method of choice.
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Affiliation(s)
| | - Julia Zimmer
- Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Benno Ure
- Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Lacher
- Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Pediatric Surgery, University of Leipzig, Liebigstrasse 20A, 04103 Leipzig, Germany
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