title: A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery.
abstract: OBJECTIVE
  This study sought to demonstrate the feasibility of a risk calculator for neonates undergoing major abdominal or thoracic surgery with good discriminative ability.
  
  
  METHODS
  The American College of Surgeons' National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P) 2011-12 data were queried for neonates who underwent major abdominal or thoracic surgery. The outcome of interest was the occurrence of any adverse event, including mortality, within 30-days postoperatively. The preoperative clinical characteristics significantly associated with any adverse event were used to build a multivariate model. The model's discriminative ability was assessed with the area under the receiver operating characteristic curve (AUROC). The model was split-set validated with 2013 data.
  
  
  RESULTS
  A total of 2967 neonates undergoing major abdominal or thoracic surgery were identified. The overall rate of adverse events was 23.3%. Sixteen variables were found to be associated with adverse events. Four variables increased the odds of adverse events at least two-fold: dirty or infected wound class [odds ratio (OR)=2.1] dialysis (OR=3.8), hepatobiliary disease (OR=2.1), and inotropic agent use (OR=2.6). The AUROC=0.79 for development data and 0.77 on split-set validation.
  
  
  CONCLUSIONS
  Preoperatively estimating the probability of postoperative adverse events in neonates undergoing major abdominal or thoracic surgery with good discrimination is feasible.
authors.affiliation: Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: as013j@gmail.com.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stey
authors.affiliation: Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
authors.affiliation: Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
authors.affiliation: American College of Surgeons, Chicago, IL, USA; Washington University School of Medicine in Saint Louis, Department of Surgery, Olin Business School, and Center for Health Policy, St Louis VA Medical Center, BJC Healthcare, Saint Louis, MO, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Berman
authors.affiliation: American College of Surgeons, Chicago, IL, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.affiliation: American College of Surgeons, Chicago, IL, USA.
authors.forename: Kari
authors.initials: K
authors.lastname: Kraemer
authors.affiliation: David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; American College of Surgeons, Chicago, IL, USA.
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Vinocur
mesh_terms: D000005:Abdomen / Q000601:surgery*; D019540:Area Under Curve; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000401:mortality
keywords: Neonatal surgery; Risk calculator