title: Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit.
abstract: OBJECTIVE
  The purpose of this study is to record the 30-day and inpatient morbidity and mortality in paediatric patients in a tertiary neuroscience centre over a 2-year period. The intentions were to establish the frequency of significant adverse events, review the current published rates of morbidity in paediatric neurosurgical patients and propose three clinical indicators for future comparison.
  
  
  METHODS
  All deaths and adverse events were prospectively recorded from 1 January 2014 to 31 December 2015. Each adverse event was categorised, allocated a clinical impact severity score and linked to a neurosurgical procedure wherever possible. Where a patient suffered several adverse events in the same admission, each event was recorded separately. If a patient had been discharged home, an adverse event was recorded if it occurred within 30 days of admission.
  
  
  RESULTS
  Five hundred forty-nine procedures were performed in 287 patients (aged <16 years). One hundred thirty significant adverse events were identified. The following are the three clinical indicators: significant adverse event rate: 111 (20.2%) operations were linked to at least one significant adverse event; unscheduled return to theatre rate: 81 (14.8%) operations were associated with an adverse event that resulted in an unscheduled return to theatre; and surgical site infection rate: 29 (5.3%) operations were associated with an infection.
  
  
  CONCLUSIONS
  Complications and adverse events are common in paediatric neurosurgery. Prospective, continuous surveillance will promote both quality assurance and quality improvement in the neurosurgical care delivered to patients.
authors.affiliation: Department of Paediatric Neurosurgery, Royal Hospital for Children, 1345, Govan Road, Glasgow, Scotland, G51 4TF, UK. emercampbell@doctors.org.uk.
authors.forename: Emer
authors.identifier: http://orcid.org/0000-0001-8886-5137
authors.initials: E
authors.lastname: Campbell
authors.affiliation: Department of Paediatric Neurosurgery, University Hospital, Dusseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beez
authors.affiliation: Department of Paediatric Neurosurgery, Royal Hospital for Children, 1345, Govan Road, Glasgow, Scotland, G51 4TF, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Todd
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality*; D010372:Pediatrics; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors
keywords: Adverse event; Complication; Neurosurgery; Paediatric; Surveillance