Viviane G. Nasr, M.D.; Steven J. Staffa, M.S.; David Zurakowski, M.S., Ph.D.; James A. DiNardo, M.D., F.A.A.P.; David Faraoni, M.D., Ph.D., F.A.H.A.
Anesthesiology 6 2019, Vol.130, 971-980
The global incidence of perioperative mortality in the pediatric surgical population is extremely low. However, the incidence of 30-day mortality can vary from 0.1 to 15% dependent on the patient’s comorbidities and physical status at the time of surgery.1–3 During the past decade, several groups have developed risk stratification models to improve prediction of perioperative major event (including death) in adults and enhance perioperative discussion of risk among physicians and the family, as well as improve resource allocation.4–7 The development of comparable risk stratification models has been undertaken in the pediatric surgical population as well.1,8
In a recent study, we developed the Pediatric Risk Assessment score to predict perioperative mortality in neonates, infants, and children undergoing noncardiac surgery.1 The score includes patient’s age (e.g., less than 12 months), the presence of a neoplasm, the degree of emergency of the surgical procedure, the presence of at least one comorbidity (e.g., respiratory disease, congenital heart disease, kidney insufficiency, neurologic or hematologic disease), and characteristics of critical illness (e.g., mechanical ventilation, inotropic support, preoperative cardiopulmonary resuscitation). The score’s internal validation in a large cohort demonstrated an excellent accuracy in predicting perioperative mortality in children undergoing noncardiac surgery; however, the intrinsic risk of the surgical procedure was not included into our predictive model. Read More