Comparison of pediatric perioperative risk assessment by <scp>ASA</scp> physical status and by <scp>NARCO</scp>‐<scp>SS</scp> (neurological, airway, respiratory, cardiovascular, other–surgical severity) scores

Udupa, Ashwin N.; Ravindra, Madhavi; Chandrika, Y R; Chandrakala, Kunigal Ravishankar; Bindu, N.; Watcha, Mehernoor F.

doi:10.1111/pan.12588

Cited by 25 publications

(45 citation statements)

References 18 publications

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“…Although this finding may seem intuitive, it is important to convey because the preoperative active health issues in the current study are not routinely included in existing tools that are used to assess surgical risk. [12][13][14][15][16][17][18][19][20] Rather, those tools emphasize the presence of a chronic condition in a specific organ system (eg, respiratory) without incorporating perioperative clinical judgment on the effects of that condition and its impact on the child's perioperative health and safety. In the CART analysis of the current study, it was revealed that preoperative active health issues had the strongest influence on PoPD with lower-risk procedures (eg, tonsillectomy or adenoidectomy); for those procedures, PoPD was nearly 80% more likely in patients with versus without a preoperative active health issue.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Existing tools with a predominate focus on chronic conditions (eg, oncologic diseases and neuromuscular disorders) that are used to predict specific pediatric surgical complications have been helpful in this area. [12][13][14][15][16][17][18][19][20] However, previous studies and our clinical experience suggest that clinicians continue to subjectively assess and imprecisely convey surgical risks. 21 There are 2 key gaps in knowledge that, when filled, may help this situation.…”

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confidence: 99%

“…A limited number of significant yet rare preoperative acute issues, including acute kidney injury, acute respiratory failure, and cardiovascular instability, have been evaluated in previous studies. [12][13][14][15][16][17][18][19][20] Although important, the vast majority of children undergoing elective surgery do not experience those issues preoperatively. Assessment of more common preoperative health issues is needed.…”

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confidence: 99%

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Predicting Postoperative Physiologic Decline After Surgery

Berry

Johnson

Crofton³

et al. 2019

Pediatrics

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BACKGROUND: Projecting postoperative recovery in pediatric surgical patients is challenging. We assessed how the patients' number of complex chronic conditions (CCCs) and chronic medications interacted with active health issues to influence the likelihood of postoperative physiologic decline (PoPD). METHODS: A prospective study of 3295 patients undergoing elective surgery at a freestanding children's hospital. During preoperative clinical evaluation, active health problems, CCCs, and medications were documented. PoPD (compromise of cardiovascular, respiratory, and/or neurologic systems) was measured prospectively every 4 hours by inpatient nurses. PoPD odds were estimated with multivariable logistic regression. Classification and regression tree analysis distinguished children with the highest and lowest likelihood of PoPD. RESULTS: Median age at surgery was 8 years (interquartile range: 2-15); 2336 (70.9%) patients had a CCC; and 241 (7.3%) used $11 home medications. During preoperative evaluation, 1556 (47.2%) patients had $1 active health problem. After surgery, 882 (26.8%) experienced PoPD. The adjusted odds of PoPD were 1.2 (95% confidence interval [CI]: 1.0-1.4) for presence versus absence of an active health problem; 1.4 (95% CI: 1.0-1.9) for $11 vs 0 home medications; and 2.2 (95% CI: 1.7-2.9) for $3 vs 0 CCCs. In classification and regression tree analysis, the lowest rate of PoPD (8.6%) occurred in children without an active health problem at the preoperative evaluation; the highest rate (57.2%) occurred in children with a CCC who used $11 home medications. CONCLUSIONS: Greater than 1 in 4 pediatric patients undergoing elective surgery experienced PoPD. Combinations of active health problems at preoperative evaluation, polypharmacy, and multimorbidity distinguished patients with a low versus high risk of PoPD.

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confidence: 99%

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Predicting Postoperative Physiologic Decline After Surgery

Berry

Johnson

Crofton³

et al. 2019

Pediatrics

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“…24 Do sada jedinu nezavisnu ocjenu značajka mjernog sustava NARCO-SS i usporedbu njegove pouzdanosti u procjeni perioperacijskih ishoda s ASA-inim statusom proveli su Udupa A. i suradnici. 25 Oni zaključuju da je NARCO-SS vrijedan alat za procjenu rizika koji bolje korelira sa stopom neželjenih ishoda anestezije u djece u odnosu prema prediktivnoj vrijednosti ASA-ina statusa. Sustav NARCO-SS kritiziran je zbog svoje složenosti te se postavilo pitanje je li praktičan.…”

Section: Bodovni Sustav Narco-ss Procjene Prijeanestezijskog Rizika Uunclassified

Assessment of Preoperative Risk in Children

2018

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Sažetak. Prijeoperacijska procjena zdravstvenog stanja bolesnika neizostavni je dio planiranja svakog zahvata pri kojemu se bolesnik podvrgava anesteziji. Klasifi kacija fi zikalnog statusa bolesnika Američkog društva anesteziologa (engl. The American Society of Anesthesiologists-ASA) danas se rutinski rabi za procjenu rizika od anestezije i perioperacijske smrtnosti bolesnika neovisno o dobi. Međutim, kao što se anestezija u djece razlikuje od anestezije u odraslih, nužno je i u prijeanestezijskoj procjeni rizika uzeti u obzir osobitosti dječje dobi. Radi kvalitetne procjene rizika od anestezije razvili su se novi sustavi procjene rizika i specifi čne smjernice prijeanestezijske obrade u djece. Ukratko su prikazana dva nova alata za procjenu prijeanestezijskog rizika u djece: bodovni sustav PRAm (Pediatric Risk Assessment score) i sustav NARCO-SS (engl. neurological, airway, respiratory, cardiovascular, other-surgical severity). Cilj je rada kritički osvrt na postojeće smjernice procjene prijeanestezijskog rizika u djece. Prijeoperacijskom procjenom rizika i pripremom za anesteziju prilagođenom dječjoj dobi mogu se unaprijediti sigurnost i uspjeh anesteziološkog postupka u djece.

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“…Esse sistema mostra taxa preditiva mais acurada de eventos adversos e possibilita mais intensificação de cuidados, comparado ao ASA-os. 4 ro especial, favorecendo o planejamento perioperatório, baseado no uso apropriado dos recursos hospitalares e programação das atividades cirúrgicas de acordo com as características clínicas do paciente. 2…”

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Preoperative evaluation in pediatric anesthesia

Braga¹,

Queiroz²,

Arantes³

et al. 2017

Revista Médica De Minas Gerais

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A consulta pré-operatória para anestesia pediátrica tem importância vital no processo de avaliação da condição clínica do paciente e visa definir os riscos e elegibilidade da anestesia e cirurgia, com informações essenciais para a tomada de decisões a partir de anamnese e exame físico. Estes visam complementar o planejamento da anestesia, bem como a necessidade de medicação pré-anestésica e preparo não farmacológico. É uma responsabilidade intransferível do anestesiologista e a partir dessa avaliação é possível definir o estado físico da criança, os riscos anestésico e cirúrgico, necessidade de solicitação de exames complementares, tratamento ou preparo especial, favorecendo o planejamento perioperatório, baseado no uso apropriado dos recursos hospitalares e programação das atividades cirúrgicas de acordo com as características clínicas do paciente. ABSTRACTThe pre-operative consultation for Pediatric Anesthesia has vital importance in assessment of patient's preoperative clinical condition and seeks to define risks and eligibility of anesthesia and surgery, with essential information to decision-making, regarding to anamnesis and physical examination, which aim to complement anesthesia planning, as well as the need for pharmacologic and non-pharmacological preoperative preparation. The responsibility of the anesthesiologist is non-transferable, and from this evaluation, it is possible to define the physical state of the child, anesthetic and surgical risks and the need to request preoperatively complementary examination, treatment or special preparation, favoring the perioperative planning, based on the appropriate use of hospital resources and programming surgical activities according to the clinical characteristics of the patient.A consulta pré-operatória tem importância vital no processo de avaliação da condição clínica do paciente e visa definir os riscos e elegibilidade da anestesia e cirurgia. As informações obtidas são necessárias para tomada de decisões a partir da anamnese, exame físico e exames complementares. Essa é uma responsabilidade intransferível do anestesiologista, apesar de profissionais de outras especialidades médicas poderem fornecer informações adicionais importantes durante esse processo. 1 A partir dessa avaliação, é possível definir o estado físico da criança, os riscos anestésico e cirúrgico, necessidade de solicitação de exames, tratamento ou prepa-

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Comparison of pediatric perioperative risk assessment by ASA physical status and by NARCO‐SS (neurological, airway, respiratory, cardiovascular, other–surgical severity) scores

Cited by 25 publications

References 18 publications

Predicting Postoperative Physiologic Decline After Surgery

Predicting Postoperative Physiologic Decline After Surgery

Assessment of Preoperative Risk in Children

Preoperative evaluation in pediatric anesthesia

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