Prognostic profiling of children with serious post-operative complications: A novel probability model for failure to rescue

Mpody, Christian; Arends, Jordan; Aldrink, Jennifer H.; Olutoye, Oluyinka O.; Tobias, Joseph D.; Nafiu, Olubukola O.

doi:10.1016/j.jpedsurg.2020.09.054

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…Failure to rescue (FTR; ie, probability of postoperative death given a complication) was calculated as a surrogate for surgical mortality. 11,12 The Da Vinci Xi Surgical System (Intuitive Surgical Inc., CA) was used in all children. Procedures were carried out by different surgeons (experienced surgeons and trainees); none had prior experience in robotic surgery before the start of our robotic program but all had extensive experience in laparoscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Robot-specific complications (ie, those that may have been avoided using a different surgical approach) were also recorded, along with length of stay (LOS), intensive care unit (ICU) stay, and survival on follow-up. Failure to rescue (FTR; ie, probability of postoperative death given a complication) was calculated as a surrogate for surgical mortality 11,12 …”

Section: Methodsmentioning

confidence: 99%

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Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study

Vinit

Vatta²,

Broch³

et al. 2023

Annals of Surgery

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To report one-year morbidity of robotic-assisted laparoscopic surgery (RALS) in a dedicated, multidisciplinary, pediatric robotic surgery program. Summary Background Data. RALS in pediatric surgery is expanding, but data on morbidity in children is limited. Methods: All children who underwent RALS (Da Vinci Xi, Intuitive Surgical, USA) were prospectively included (October 2016 to May 2020; follow-up ≥1 year). Analyzed data: patient characteristics, surgical indication/procedure, intraoperative adverse events (ClassIntra classification), blood transfusion, hospital stay, postoperative complications (Clavien-Dindo). Results: Three hundred consecutive surgeries were included: urology/ gynecology (n=105), digestive surgery (n=83), oncology (n=66), ENT surgery (n=28), thoracic surgery (n=18). Median age and weight at surgery were 9.5 [interquartile range (IQR)=8.8] years and 31 [IQR=29.3] kg, respectively. Over one year, 65 (22%) children presented with ≥1 complication, with Clavien-Dindo ≥III in 14/300 (5%) children at ≤30 days, 7/300 (2%) at 30-90 days, and 12/300 (4%) at >90 days. Perioperative transfusion was necessary in 15 (5%) children, mostly oncological (n=8). Eight (3%) robotic malfunctions were noted, one leading to conversion (laparotomy). Overall conversion rate was 4%. ASA ≥3, weight ≤15 kg, and surgical oncology did not significantly increase the conversion rate, complications, or intraoperative adverse events (ClassIntra ≥2). ASA score was significantly higher in children with complications (Clavien-Dindo ≥III) than without (p=0.01). Median hospital stay was 2 [IQR=3] days. Three children died after a median follow-up of 20 [IQR=16] months. Conclusions: RALS is safe, even in the most vulnerable children with a wide scope of indications, age, and weight. Robot-specific complications or malfunctions are scarce.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study

Vinit

Vatta²,

Broch³

et al. 2023

Annals of Surgery

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“…Although FTR has been extensively studied in adults, there are concerns related to operationalizing FTR as a pediatric quality measure (12–18). Previous work from our group identified an association between hospital-level risk adjusted mortality and FTR (4).…”

mentioning

confidence: 99%

Utility of Hospital Failure to Rescue for Analyzing Variation in Pediatric Postoperative Mortality

Mehl,

Portuondo,

Tian

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To evaluate the association between pediatric hospital performances in terms of failure to rescue (FTR), defined as postoperative mortality after a surgical complication, and mortality among patients without a surgical complication. Design: Retrospective cohort study. Setting: Forty-eight academic, pediatric hospitals; data obtained from Pediatric Health Information System database (Child Health Corporation of America, Shawnee Mission, KS) (2012–2020). Patients: Children who underwent at least one of 57 high-risk operations associated with significant postoperative mortality. Exposures: Hospitals were stratified into quintiles of reliability adjusted FTR (lower than average FTR in quintile 1 [Q1], higher than average FTR in quintile 5 [Q5]). Multivariable hierarchical regression was used to evaluate the association between hospital FTR performance and mortality among patients who did not have a surgical complication. Measurements and Main Results: Among 203,242 children treated across 48 academic hospitals, the complication and overall postoperative mortality rates were 8.8% and 2.3%, respectively. Among patients who had a complication, the FTR rate was 8.8%. Among patients who did not have a complication, the mortality rate was 1.7%. There was a 6.5-fold increase in reliability adjusted FTR between the lowest and highest performing hospitals (lowest FTR hospital—2.7%; 95% CI [1.6–3.9]; highest FTR hospital—17.8% [16.8–18.8]). Complex chronic conditions were highly prevalent across hospitals (Q1, 72.7%; Q2, 73.8%; Q3, 72.2%; Q4, 74.0%; Q5, 74.8%; trend test p < 0.01). Relative to Q1 hospitals, the odds of mortality in the absence of a postoperative complication significantly increased by 33% at Q5 hospitals (odds ratio 1.33; 95% CI [1.07–1.66]). This association was consistent when limited to patients with a complex chronic condition and neonates. Conclusion: FTR may be a useful and valid surgical quality measure for pediatric surgery, even when considering patients without a postoperative complication. These findings suggest practices and processes for preventing FTR at high performing pediatric hospitals might help mitigate the risk of postoperative mortality even in the absence of a postoperative complication.

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“…[5][6][7][8][9] Despite an extensive body of literature investigating adult FTR, only recently have studies begun to evaluate FTR as a potential quality measure for pediatric surgery. [10][11][12][13][14][15][16][17][18] Our group previously identified a dose-response relationship between the number of postoperative complications and FTR after both lowrisk and high-risk procedures. 11 These findings suggest the pattern of FTR in pediatric patients appears to mirror that observed in adults-specifically, FTR occurs after a cascade of postoperative complications.…”

mentioning

confidence: 99%

“…Despite an extensive body of literature investigating adult FTR, only recently have studies begun to evaluate FTR as a potential quality measure for pediatric surgery 10–18 . Our group previously identified a dose-response relationship between the number of postoperative complications and FTR after both low-risk and high-risk procedures 11 .…”

mentioning

confidence: 99%

Hospital Variation in Mortality After Inpatient Pediatric Surgery

et al. 2022

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Objective: The aim was to determine the association between risk adjusted hospital perioperative mortality rates, postoperative complications, and failure to rescue (FTR) after inpatient pediatric surgery. Background: FTR has been identified as a possible explanatory factor for hospital variation in perioperative mortality in adults. However, the extent to which this may be the case for hospitals that perform pediatric surgery is unclear. Methods: The Pediatric Health Information System database (2012–2020) was used to identify patients who underwent one of 57 high-risk operations associated with significant perioperative mortality (n=203,242). Academic, pediatric hospitals (n=48) were stratified into quintiles based on risk adjusted inpatient mortality [lower than average, quintile 1 (Q1); higher than average, quintile 5 (Q5)]. Multivariable hierarchical regression was used to evaluate the association between hospital mortality rates, complications, and FTR. Results: Inpatient mortality, complication, and FTR rates were 2.3%, 8.8%, and 8.8%, respectively. Among all patients who died after surgery, only 34.1% had a preceding complication (Q1, 36.1%; Q2, 31.5%; Q3, 34.7%; Q4, 35.7%; Q5, 32.2%; trend test, P=0.49). The rates of observed mortality significantly increased across hospital quintiles, but the difference was <1% (Q1, 1.9%; Q5; 2.6%; trend test, P<0.01). Relative to Q1 hospitals, the odds of complications were not significantly increased at Q5 hospitals [odds ratio (OR): 1.02 (0.87–1.20)]. By comparison, the odds of FTR was significantly increased at Q5 hospitals [OR: 1.60 (1.30–1.96)] with a dose-response relationship across hospital quintiles [Q2—OR: 0.99 (0.80–1.22); Q3—OR: 1.26 (1.03–1.55); Q4—OR: 1.33 (1.09–1.63)]. Conclusions: The minority of pediatric surgical deaths are preceded by a postoperative complication, but variation in risk adjusted mortality across academic, pediatric hospitals may be partially explained by differences in the recognition and management of postoperative complications. Additional work is needed to identify children at greatest risk of postoperative death from perioperative complications as opposed to those at risk from pre-existing chronic conditions.

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Prognostic profiling of children with serious post-operative complications: A novel probability model for failure to rescue

Cited by 6 publications

References 41 publications

Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study

Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study

Utility of Hospital Failure to Rescue for Analyzing Variation in Pediatric Postoperative Mortality

Hospital Variation in Mortality After Inpatient Pediatric Surgery

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