Perioperative Risk Factors for Surgical Complications in Pediatric Urology: A Pilot Study in Preoperative Risk Assessment in Children

Objectives

To elucidate which perioperative patient characteristics are associated with an increased risk of complications in pediatric urological surgery. There are numerous published studies that have correlated comorbidities, preoperative, and intraoperative parameters with postoperative outcomes in adults. However, there is a paucity of similar data in the pediatric population.

Methods

Between July 2003 and September 2006, a total of 93 children had an adverse or unexpected event within 35 days of urologic surgery. Thirty-eight preoperative patient characteristics and 20 perioperative parameters were evaluated. The severity of the complications was graded based on the Clavien classification. A total of 163 controls were randomly selected. Statistical significance was assessed by univariate and multivariate analysis.

Results

The overall complication rate was 1.1%. Most complications were technical in nature, occurred within 3 days after surgery, and classified as Clavien's grade 3 B. On multivariate analysis, weight less than fifth percentile, pulmonary or hematologic comorbidity, surgery duration >2 hours, first operation, low intraoperative heart rate, and the use of intravenous anesthesia were determined to be independent risk factors, whereas “other” medication was the only independent protective factor.

Conclusions

We observed that some of the parameters conventionally thought to be risk factors for surgical complications such as multiple medical comorbidities, repeat operation, and American Society of Anesthesiologists' Classification of Physical Status score were not significant predictors of postoperative complications, whereas others were unexpectedly significant. Future prospective studies will be needed to fully stratify risk and guide risk interventions to improve postoperative outcomes.