AI Article Synopsis
- Postoperative adverse events in pediatric surgery were studied to evaluate the effectiveness of various severity grading systems, as these events can lead to significant health issues.
- Over a period from 2017 to 2020, 6,296 pediatric surgeries were documented, revealing that 10.7% of patients experienced adverse events, with the Clavien-Dindo grading system providing the most detailed assessments, albeit with limited additional benefits.
- The Comprehensive Complication Index (CCI®) showed strong correlation with other grading systems and was particularly useful for analyzing multiple events in individual patients, suggesting its recommendation for future studies in pediatric surgery.
Article Abstract
Background: Postoperative adverse events may be associated with substantial morbidity and mortality. Numerous severity grading systems for these events have been introduced and validated but have not yet been systematically applied in paediatric surgery. This study aimed to analyse the advantages and disadvantages of these classifications in a paediatric cohort.
Methods: Unexpected events associated with interventional or organizational problems in the department of paediatric surgery during 2017-2020 were prospectively documented daily for all children. Events were classified according to the Clavien-Dindo grading system during monthly morbidity and mortality conferences. All events were also classified according to five additional grading systems: T92, contracted Accordion, expanded Accordion, Memorial Sloan Kettering Cancer Center, and Comprehensive Complication Index (CCI)®.
Results: Of 6296 patients, 673 (10.7 per cent) developed adverse events and 240 (35.7 per cent) had multiple events. Overall, 1253 adverse events were identified; of these, 574 (45.2 per cent) were associated with surgical or medical interventions and 679 (54.8 per cent) included organizational problems. The grading systems demonstrated high overall correlation (rpears = 0.9), with minor differences in sentinel events. The Clavien-Dindo classification offered the most detailed assessment. However, these details had only limited additional value. The CCI® scores were correlated with other grading systems (rpears = 0.9) and were useful in analysing multiple events within individual patients.
Conclusion: Grading systems demonstrated similar scoring patterns for minor and sentinel events, with none being superior for unexpected events in children. However, the CCI® can be a major improvement in assessing morbidity in patients with multiple events. Its use is therefore recommended in prospective studies on paediatric surgery.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756080 | PMC |
| http://dx.doi.org/10.1093/bjsopen/zrab138 | DOI Listing |
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