title: Perioperative hospital mortality at a tertiary paediatric institution.
abstract: BACKGROUND
  Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital.
  
  
  METHODS
  All patients <18 yr old who underwent anaesthesia with or without surgery between January 1, 2006, and December 31, 2012, at the Wilhelmina Children's Hospital, Utrecht, The Netherlands, were included in this retrospective cohort study. Causes of death within 30 days were identified and tabulated into four major categories according to principal cause.
  
  
  RESULTS
  A total of 45,182 anaesthetics were administered during this 7-yr period. The all-cause 24-hour hospital mortality was 13.1 per 10,000 anaesthetics (95% CI: 9.9-16.8) and the all-cause 30-day in-hospital mortality was 41.6 per 10,000 anaesthetics (95% CI: 35.9-48.0). In total five patients were partially contributable to anaesthesia (30-day mortality: 1.1/10,000, 95% CI: 0.4-2.6) and four patients were partially contributable to surgery (30-day mortality: 0.9/10,000, 95% CI: 0.2-2.3). Mortality was higher in neonates and infants, children with ASA physical status III and IV, and emergency- and cardiothoracic surgery.
  
  
  CONCLUSIONS
  Neonates and infants, children with ASA physical status III or poorer, and emergency- and cardiothoracic surgery are associated with a higher postoperative mortality. Anaesthesia- or surgery-related complications contribute to mortality in only a small amount of the deaths, indicating the relative safety of paediatric surgical and anaesthetic procedures.
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands Present affiliation: Department of Surgery, Amstelland Hospital, Amstelveen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: de Bruin
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Pasma
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: D B M
authors.initials: DB
authors.lastname: van der Werff
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: T A N J
authors.initials: TA
authors.lastname: Schouten
authors.affiliation: Paediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Haas
authors.affiliation: Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: D C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Wolfswinkel
authors.affiliation: Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands Brain Center Rudolph Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands j.c.degraaff-2@umcutrecht.nl.
authors.forename: J C
authors.initials: JC
authors.lastname: de Graaff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D059035:Perioperative Period / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: anaesthesia; child mortality; hospital mortality; infants, paediatrics, surgery