Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital

Griend, Benjamin Fh van der; Lister, Nichole A.; McKenzie, Ian; Martin, Nick; Ragg, Philip; Sheppard, Suzette; Davidson, Andrew

doi:10.1213/ane.0b013e318213be52

Cited by 217 publications

(198 citation statements)

References 22 publications

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“…[13][14][15][16] • High-risk patients are identified, which assists when making informed decisions on patient care. 2,17,18 • Informed consent is enhanced when immediate anaestheticrelated risk is accurately communicated to families and patients.…”

Section: Introductionmentioning

confidence: 99%

“…2,17,18 • Informed consent is enhanced when immediate anaestheticrelated risk is accurately communicated to families and patients. 13 • System issues are identified which contribute to substandard anaesthetic care, especially in middle-and low-income countries. [18][19][20][21] • Research is facilitated and can be appropriately directed to improving clinical anaesthetic safety.…”

Section: Introductionmentioning

confidence: 99%

“…8,23,27 It is the opinion of the author that simple, but inclusive definitions, are appropriate to research in the developing world. 13,31 Anaesthetic-related serious adverse events and critical incidents…”

Section: Introductionmentioning

confidence: 99%

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A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Cronjé

2015

Southern African Journal of Anaesthesia and Analgesia

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Anaesthetists increasingly face questions from parents on the long-term outcomes of anaesthesia, and yet more immediate anaesthetic risks are not understood, nor explained to families. This review focused on paediatric anaesthetic-related mortality, cardiac arrest and anaesthetic-related serious adverse events and critical incidents during general anaesthesia, and within 24 hours of anaesthesia ending. Anaesthetic-related mortality is rare in the developed world, and is approximately 1 per 10 000 anaesthetics, but increases in high-risk children. Serious anaesthetic-related adverse events occur in 1.4 per 1 000 anaesthetics in the developed world. Data are lacking from the developing world but anaesthetic mortality is 2-3 times higher in middle-income countries and may be up to 100-fold greater in low-income countries. A critical incident occurs in 3-8% of anaesthetics and this figure is double that in low-income countries. Anaesthetic-related events are predominantly preventable. Brief recommendations on preventative strategies are made and research goals outlined.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Cronjé

2015

Southern African Journal of Anaesthesia and Analgesia

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“…3,4 Anesthesiologists should recognize particular patients at higher risk of cardiac arrest, including those requiring emergency surgery, American Society of Anesthesiologists' physical status class III-V, pulmonary hypertension, and congenital heart disease. [5][6][7] Prevention of cardiac arrest is dependent on healthcare providers' early recognition of the infant or child at risk of imminent collapse. The creation of medical emergency teams or rapid response teams is an attempt to address this problem.…”

mentioning

confidence: 99%

“…3,4 Les anesthésiologistes doivent identifier les patients qui ont un risque particulièrement élevé d'arrêt cardiaque, y compris ceux qui nécessitent une chirurgie d'urgence, ont un statut physique de catégorie III-V selon l'American Society of Anesthesiologists, ou une hypertension pulmonaire, ou une cardiopathie congénitale. [5][6][7] La prévention d'un arrêt cardiaque dépend de l'identification précoce d'un nourrisson ou enfant à risque de collapsus imminent par les professionnels de la santé. La création d'équipes médicales d'urgence ou d'équipes d'intervention rapide constitue une tentative de réponse à ce problème.…”

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What’s new in pediatric resuscitation? A practical update for the anesthesiologist

Caen

Bhanji

2012

Can J Anesth/J Can Anesth

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Association of Preoperative Anemia With Postoperative Mortality in Neonates

et al. 2016

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IMPORTANCE Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population. OBJECTIVE To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals. DESIGN, SETTING, AND PARTICIPANTS Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. EXPOSURES Anemia defined as hematocrit level of less than 40%. MAIN OUTCOMES AND MEASURES Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database. RESULTS Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality. Multivariable regression analysis demonstrated that preoperative anemia is an independent risk factor for mortality (OR, 2.62; 95% CI, 1.51-4.57) in neonates. The prevalence of postoperative in-hospital mortality was significantly higher in neonates with a preoperative hematocrit level less than 40%; being 7.5% (95% CI, 1%-10%) vs 1.4% (95% CI, 0%-4%) for preoperative hematocrit levels 40%, or greater. The relationship between anemia and in-hospital mortality was confirmed in our validation cohort (National Surgical Quality Improvement Program 2014). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to define the incidence of preoperative anemia in neonates, the incidence of postoperative in-hospital mortality in neonates, and the association between preoperative anemia and postoperative mortality in US hospitals. Timely diagnosis, prevention, and appropriate treatment of preoperative anemia in neonates might improve survival.

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Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital

Abstract: Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children.

Cited by 217 publications

References 22 publications

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

What’s new in pediatric resuscitation? A practical update for the anesthesiologist

Association of Preoperative Anemia With Postoperative Mortality in Neonates

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