Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit

Abstract

PurposeThe purpose of this study is to record the 30-day and inpatient morbidity and mortality in paediatric patients in a tertiary neuroscience centre over a 2-year period. The intentions were to establish the frequency of significant adverse events, review the current published rates of morbidity in paediatric neurosurgical patients and propose three clinical indicators for future comparison.MethodsAll deaths and adverse events were prospectively recorded from 1 January 2014 to 31 December 2015. Each adverse event was categorised, allocated a clinical impact severity score and linked to a neurosurgical procedure wherever possible. Where a patient suffered several adverse events in the same admission, each event was recorded separately. If a patient had been discharged home, an adverse event was recorded if it occurred within 30 days of admission.ResultsFive hundred forty-nine procedures were performed in 287 patients (aged <16 years). One hundred thirty significant adverse events were identified. The following are the three clinical indicators: significant adverse event rate: 111 (20.2%) operations were linked to at least one significant adverse event; unscheduled return to theatre rate: 81 (14.8%) operations were associated with an adverse event that resulted in an unscheduled return to theatre; and surgical site infection rate: 29 (5.3%) operations were associated with an infection.ConclusionComplications and adverse events are common in paediatric neurosurgery. Prospective, continuous surveillance will promote both quality assurance and quality improvement in the neurosurgical care delivered to patients.

Neurosurgical morbidity in pediatric supratentorial midline low‐grade glioma: Results from the German LGG studies

“…New neurological deficits occurred more frequently following interventions for brain tumors as compared to other indications in a series of 769 craniotomies in pediatric patients 42 . In another large series of general pediatric neurosurgical interventions, almost half of the complications were cerebrovascular bleedings and only a minor fraction surgical brain injuries 24,39,40 . The prevalence of almost 50% postoperative neurological disturbances in our SML‐LGG cohort corroborates findings of a Dutch single‐center report on pediatric brain tumor patients 43 .…”

“…It allows an appropriate grouping of surgical and medical morbidity and identifies same complications occurring with different procedures. Linking each complication to an individual intervention, the Drake system created a countable denominator instead of linking the adverse event rate to individual patients 24 …”

“…15 Most studies on pLGG focused on epidemiology, neuropathological features or different nonsurgical treatment approaches. 20,23 Complications and related impairments following neurosurgery in pLGG of these challenging SML regions are rarely reported, 24,25 sometimes only aside to other aspects. 9,[26][27][28][29][30] Therefore, we analyzed data from patients treated within the comprehensive therapy algorithm of the successive German pediatric LGG multicenter studies for the frequency of neurosurgical morbidity.…”

Morbimortalidad asociada al Departamento de Neurocirugía del Hospital de Clínicas. Estudio longitudinal retrospectivo durante el período Abril 2017-2019.

“…Complicación neuroquirúrgica es cualquier resultado adverso directo no deseado de una cirugía que aparece hasta 30 días luego de la misma (3) . El resultado de esta complicación puede determinar morbilidad y/o mortalidad en el paciente.…”

Staphylococcus aureus infections after elective pediatric surgeries

“…9 Most studies of pediatric postsurgical S. aureus infections have focused on limited surgery types and/or were conducted in single centers with large institutional variability. 2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] National-level estimates of pediatric postoperative S. aureus infections based on realworld microbiological data are lacking. Surgeries planned during an elective admission may provide an opportunity to maximize perioperative preventative measures to decrease postoperative infections (eg, through a potential vaccine).…”