Postoperative complications following neonatal and infant surgery: Common events and predictive factors.
BACKGROUND
Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors.


METHODS
The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics.


RESULTS
The study included 168 patients. Their postnatal age was 48±48days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise (n=19, 11.3%), multiple organ dysfunction syndrome (MODS, n=8, 4.8%) and respiratory failure requiring ventilation (n=3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA<40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration.


CONCLUSIONS
This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications.
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Daphné
D
Michelet
Department of General and Urological Surgery, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France.
Christopher
C
Brasher
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Houssam Ben
HB
Kaddour
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Thierno
T
Diallo
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Rachida
R
Abdat
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Serge
S
Malbezin
Department of Anaesthesia & Pain Management, Royal Children's Hospital, 3000 Melbourne, Australia; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France.
Arnaud
A
Bonnard
Department of Anaesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75000 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75000 Paris, France. Electronic address: souhayl.dahmani@rdb.aphp.fr.
Souhayl
S
Dahmani
D000758:Anesthesia; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000453:epidemiology; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology; D006439:Hemodynamics; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D006819:Hyaline Membrane Disease / Q000150:complications / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
Complications; Infants; Neonates; Surgery