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

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 ope...

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Bibliographic Details
Published in:	PloS one Vol. 13; no. 1; p. e0191176
Main Authors:	Akbilgic, Oguz, Langham, Jr, Max R, Walter, Arianne I, Jones, Tamekia L, Huang, Eunice Y, Davis, Robert L
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 19-01-2018 Public Library of Science (PLoS)
Subjects:	60 APPLIED LIFE SCIENCES Adolescent Age Anesthesia Biology and Life Sciences Child Child Mortality Child, Preschool Children Children & youth Classification Comorbidity Databases, Factual Datasets Death Engineering and Technology Female Health risk assessment Hospital Mortality Humans Infant Infant Mortality Infant, Newborn Informatics Laboratories Logistic Models Male Medicine and Health Sciences Methods Mortality Neonates Newborn babies Oxygen Patients Pediatric surgery Pediatrics Perinatal Mortality Physical Sciences Postoperative Complications - mortality Postoperative Complications - prevention & control Preventive medicine Quality control Quality Improvement Quality management Research and Analysis Methods Risk Risk Assessment Risk Factors Risk groups Science & Technology - Other Topics Sepsis Statistical analysis Subpopulations Surgeons Surgery Surgical Procedures, Operative - mortality Time Factors United States - epidemiology Variables Ventilation United States United States > US Tennessee
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 USDOE Office of Science (SC) AC05-00OR22725 Competing Interests: The authors have declared that no competing interests exist. These authors also contributed equally to this work.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0191176