S. B. Cairo2, B. Tabak1,2, L. Berman4, S. K. Berkelhamer3, D. H. Rothstein1,2 1State University Of New York At Buffalo,Pediatric Surgery,Buffalo, NY, USA 2Women And Children’s Hospital Of Buffalo,Pediatric Surgery,Buffalo, NY, USA 3Women And Children’s Hospital Of Buffalo,Neonatology,Buffalo, NY, USA 4Nemours Alfred I. DuPont Hospital For Children,Pediatric Surgery,Wilmington, DE, USA
Introduction:
Premature infants undergoing abdominal operations early in life are thought to have high perioperative mortality. Risk factors for mortality beyond simple prematurity are poorly understood. This study seeks to quantify 30-day mortality in premature infants undergoing emergency abdominal operations during the first two months of life to better inform interdisciplinary and family discussions surrounding operative risks.
Methods:
Retrospective descriptive analysis of premature infants undergoing emergency abdominal operations during the first two months of life using the National Surgical Quality Improvement Project, Pediatric. Crude mortality rates were calculated and stratified by gestational age (GA) and presence of risk factors for death. Birth weight for gestational age, gender, weight at time of operation, race/ethnicity, American Society of Anesthesia (ASA) class, cardiac risk factors, ventilator support and inotrope support at time of operation, and intraventricular hemorrhage (IVH) grade were incorporated into a logistic regression model using stepwise adjustment to calculate adjusted odds ratios for mortality.
Results:
During the 2012-2014 study period, 1,004 premature infants were identified who underwent emergency abdominal operations in the first two months of life. Unadjusted 30-day mortality rates ranged from 27% for infants ≤ 24 weeks’ gestational age, to 4% for 35-36 week gestational age infants (Figure). Decreasing mortality correlated closely with increasing gestational age (R2 = 0.98 for logistic regression). In a multivariate regression model, female gender (aOR 1.58, 95% C.I. 1.09-2.30), race/ethnicity other than “White, non-Hispanic” (aOR 1.97, 95% C.I. 1.33-2.89), ventilator support at time of operation (aOR 5.19, 95% C.I. 2.16-12.48), highest ASA class (3.28, 95% C.I. 2.06-5.24) and inotropic support at time of operation (aOR 3.58, 95% C.I. 2.43-5.28) were significantly associated with increased 30-day mortality. None of the following appeared to correlate with increased mortality: birth weight for gestational age, weight at time of surgery, cardiac risk factors, pre-operative steroid use, or presence of IVH.
Conclusion:
Premature infants undergoing emergency abdominal operations in the first two months of life have expectedly high 30-day mortality rates. Female gender, race/ethnicity other than White/non-Hispanic, highest ASA class, inotropic support and ventilator support are independently associated with increased mortality. These data may be helpful in guiding counseling and the informed consent process for families of high-risk neonates.
