Columbus, OH - March 2016
Mining a database of urologic surgeries, researchers at Nationwide Children's Hospital have identified preoperative risk factors for children undergoing pure genitourinary surgery and confirmed that children undergoing urologic surgery involving the bowel suffer significantly more postoperative complications.
Among pure genitourinary patients, older age and white race improved some outcomes while total operative time, obesity, pulmonary risk factors and other comorbidities independently predicted at least one negative outcome.
The study is a step toward stratifying risk for children entering urologic surgery, with the long-term goals of improving surgical planning, patient care following surgery and family counseling. While stratification has been used to direct and improve care for adult urologic surgery patients for some time, only recently has pediatric data become available to study.
"The hope is we can counsel parents better with appropriate expectations before surgery and, where possible, modify preoperative factors that lead to negative outcomes, "said Daryl McLeod, MD, a member of the Section of Urology at Nationwide Children's and an author of the study.
The researchers appear to be the first to publish an assessment of urologic preoperative risk factors using the National Surgical Quality Improvement Program (NSQIP) Pediatric. Data was submitted by 61 sites from across the United States in 2012-2013.
McLeod's team analyzed the records of 2,601 patients, ages 2 to 18. Of those, 399 underwent bowel-involved surgery and 2,202 underwent pure genitourinary surgery.
"We confirmed what a lot of people have realized: kids who undergo reconstruction using a piece of intestine had greater comorbidities, and their surgeries were larger and longer," McLeod said.
Compared to pure genitourinary patients, the group had more complications following surgery and unplanned returns to the operating room, longer hospital stays and higher readmission rates.
When they separated the two groups, researchers identified preoperative risk factors for pure genitourinary patients. In addition to those listed above, they found that preoperative renal disease, developmental delays, structural abnormalities in the central nervous system, reliance on supplemental nutrition and a ranking of class 3 or higher on the American Society of Anesthesiologists' Physical Status Classification System independently predicted at least one negative outcome.
"We were able to identify factors associated with positive and negative outcomes, but not causality," McLeod said. "As data is accumulated from more hospitals over more time, it may be used to tease out these associations. And, we hope others will use this study as a stepping stone to design studies that look more closely at these factors."
McLeod DJ, Asti L, Mahida JB, Deans KJ, Minneci PC. Preoperative risk assessment in children undergoing major urologic surgery.Journal of Pediatric Urology.2015 Jul 28.[Epub ahead of print]