title: Perioperative risk factors for major complications in pediatric surgery: a study in surgical risk assessment for children.
abstract: BACKGROUND
  There are numerous studies in the adult literature correlating comorbidities and pre- and intraoperative parameters with postoperative outcomes. However, there is a paucity of similar data in the pediatric population. Our goal was to elucidate which pre- and intraoperative patient characteristics in children undergoing surgery are associated with an increased risk of major complication within 30 days.
  
  
  METHODS
  We identified 108 children who underwent surgery at our institution between June 2005 and May 2007 and had major complication or death within 30 days of surgery. Forty-two preoperative patient characteristics and 22 intraoperative variables were evaluated. The severity of the complications was graded based on the Clavien classification system, with major complications grade III or greater. We randomly selected 723 controls who had undergone surgery within a 3-month date range of the original cohort, but did not develop complications. Statistical significance was assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Most complications were cardiovascular, occurred 1 to 3 days after surgery, and were classified as grade IIIB. We identified 5 independent risk factors on multivariate analysis: ≤36 weeks of gestation, American Society of Anesthesiologists score >3, undergoing a cardiovascular or neurosurgical procedure, and receiving an intraoperative albumin transfusion. Three scoring systems (overall, preoperative, and intraoperative complication score) were developed to provide objective risk stratification.
  
  
  CONCLUSIONS
  We found 5 patient-specific parameters that were independent risk factors for major complications or death after pediatric surgery. Future prospective studies will help to fully stratify risk and guide interventions to improve postoperative outcomes.
authors: Department of Urology, Children's Hospital Boston, Boston, MA, USA.
authors: Aaron C
authors: AC
authors: Weinberg
authors: Lin
authors: L
authors: Huang
authors: Hongyu
authors: H
authors: Jiang
authors: Bradford
authors: B
authors: Tinloy
authors: Mordechai D
authors: MD
authors: Raskas
authors: Frank J
authors: FJ
authors: Penna
authors: Drew A
authors: DA
authors: Freilich
authors: Helena B
authors: HB
authors: Buonfiglio
authors: Alan B
authors: AB
authors: Retik
authors: Hiep T
authors: HT
authors: Nguyen
mesh_terms: D001900:Boston / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000145:classification / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome