24-hour and 30-day perioperative mortality in pediatric surgery

Purpose: The low perioperative mortality rate in pediatric surgery precludes effective analysis of mortality at individual institutions. Therefore, analysis of multi-institutional data is essential to determine any patterns of perioperative death in children. The aim of this study was to determine diagnoses associated with 24-hour and 30-day perioperative mortality. Methods: A retrospective review of the 2012-2015 Pediatric Participant Use Data File (PUF) was performed. Statistical comparisons were made between survivors and nonsurvivors and between those with 24-hour and 30-day mortality using Fischer's exact tests. P-values ≤ 0.05 were considered significant. Results: 103,444 patients who underwent a pediatric surgical operation were evaluated. There were 732 deaths with a 30-day perioperative mortality of 0.7% (732/103,444). Necrotizing enterocolitis (NEC) was the diagnosis associated with the highest 30-day perioperative mortality (175/901, 19%). A significantly higher proportion NEC deaths occurred in the first 24 hours (67% (118/175) vs 33% (57/175) 30 day mortality, p < 0.001). Compared to patients who survived following operation for NEC, those who died were statistically more likely to require inotropic support (56% vs. 15%, p < 0.001), be diagnosed with sepsis (52% vs. 22%, p < 0.001), and undergo blood transfusion within 48 hours of operation (49% vs. 34%, p < 0.001). Conclusion: Although the overall pediatric surgical operative mortality rate is low, the largest proportion of perioperative deaths occur secondary to NEC. Based on the high immediate mortality, optimization of operative care for septic patients with NEC should be targeted. Type of Study: Prognosis Study Level of Evidence: Level II