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

• 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191176

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.