A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery

Anne M Stey; Brian D Kenney; R Lawrence Moss; Bruce L Hall; Loren Berman; Mark E Cohen; Kari Kraemer; Clifford Y Ko; Charles D Vinocur

doi:10.1016/j.jpedsurg.2015.03.023

A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery

J Pediatr Surg. 2015 Jun;50(6):987-91. doi: 10.1016/j.jpedsurg.2015.03.023. Epub 2015 Mar 17.

Authors

Anne M Stey¹, Brian D Kenney², R Lawrence Moss², Bruce L Hall³, Loren Berman⁴, Mark E Cohen⁵, Kari Kraemer⁵, Clifford Y Ko⁶, Charles D Vinocur⁴

Affiliations

¹ Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: as013j@gmail.com.
² Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
³ American College of Surgeons, Chicago, IL, USA; Washington University School of Medicine in Saint Louis, Department of Surgery, Olin Business School, and Center for Health Policy, St Louis VA Medical Center, BJC Healthcare, Saint Louis, MO, USA.
⁴ Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE, USA.
⁵ American College of Surgeons, Chicago, IL, USA.
⁶ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; American College of Surgeons, Chicago, IL, USA.

PMID: 25824439
DOI: 10.1016/j.jpedsurg.2015.03.023

Abstract

Purpose: This study sought to demonstrate the feasibility of a risk calculator for neonates undergoing major abdominal or thoracic surgery with good discriminative ability.

Methods: The American College of Surgeons' National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P) 2011-12 data were queried for neonates who underwent major abdominal or thoracic surgery. The outcome of interest was the occurrence of any adverse event, including mortality, within 30-days postoperatively. The preoperative clinical characteristics significantly associated with any adverse event were used to build a multivariate model. The model's discriminative ability was assessed with the area under the receiver operating characteristic curve (AUROC). The model was split-set validated with 2013 data.

Results: A total of 2967 neonates undergoing major abdominal or thoracic surgery were identified. The overall rate of adverse events was 23.3%. Sixteen variables were found to be associated with adverse events. Four variables increased the odds of adverse events at least two-fold: dirty or infected wound class [odds ratio (OR)=2.1] dialysis (OR=3.8), hepatobiliary disease (OR=2.1), and inotropic agent use (OR=2.6). The AUROC=0.79 for development data and 0.77 on split-set validation.

Conclusion: Preoperatively estimating the probability of postoperative adverse events in neonates undergoing major abdominal or thoracic surgery with good discrimination is feasible.

Keywords: Neonatal surgery; Risk calculator.

Publication types

Observational Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Abdomen / surgery*
Area Under Curve
Decision Support Techniques*
Female
Humans
Infant, Newborn
Male
Multivariate Analysis
Odds Ratio
Postoperative Complications / diagnosis*
Postoperative Complications / epidemiology
Postoperative Complications / etiology
ROC Curve
Registries
Risk Assessment
Risk Factors
Thoracic Surgical Procedures* / mortality