Perioperative risk factors for major complications in pediatric surgery: a study in surgical risk assessment for children

J Am Coll Surg. 2011 May;212(5):768-78. doi: 10.1016/j.jamcollsurg.2011.02.006. Epub 2011 Mar 23.


Background: There are numerous studies in the adult literature correlating comorbidities and pre- and intraoperative parameters with postoperative outcomes. However, there is a paucity of similar data in the pediatric population. Our goal was to elucidate which pre- and intraoperative patient characteristics in children undergoing surgery are associated with an increased risk of major complication within 30 days.

Study design: We identified 108 children who underwent surgery at our institution between June 2005 and May 2007 and had major complication or death within 30 days of surgery. Forty-two preoperative patient characteristics and 22 intraoperative variables were evaluated. The severity of the complications was graded based on the Clavien classification system, with major complications grade III or greater. We randomly selected 723 controls who had undergone surgery within a 3-month date range of the original cohort, but did not develop complications. Statistical significance was assessed by univariate and multivariate analyses.

Results: Most complications were cardiovascular, occurred 1 to 3 days after surgery, and were classified as grade IIIB. We identified 5 independent risk factors on multivariate analysis: ≤36 weeks of gestation, American Society of Anesthesiologists score >3, undergoing a cardiovascular or neurosurgical procedure, and receiving an intraoperative albumin transfusion. Three scoring systems (overall, preoperative, and intraoperative complication score) were developed to provide objective risk stratification.

Conclusions: We found 5 patient-specific parameters that were independent risk factors for major complications or death after pediatric surgery. Future prospective studies will help to fully stratify risk and guide interventions to improve postoperative outcomes.

MeSH terms

  • Boston / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Comorbidity
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intraoperative Complications / classification
  • Intraoperative Complications / epidemiology*
  • Logistic Models
  • Male
  • Postoperative Complications / classification
  • Postoperative Complications / epidemiology*
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Risk Assessment / methods*
  • Risk Factors
  • Surgical Procedures, Operative*
  • Treatment Outcome