C. L. Kvasnovsky1, J. Salazar1, J. Y. Chun1 1University Of Maryland Medical Center,Department Of Surgery,Baltimore, MD, USA
Introduction:
Limited data exist to assess the increased risk conferred to children with congenital malformations (CM) undergoing abdominal surgery. Children with CM are presumed to have worse outcomes postoperatively. We sought to quantify the risk of postoperative complications in children with CM, after controlling for co-morbidities.
Methods:
The 2012-2014 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) databases were queried to identify patients with and without CM, as defined by the American College of Surgeons, undergoing the 20 most common abdominal procedures in General Surgery. We assessed univariate associations between co-morbidities in patients with CM. Length of stay was compared using the Wilcoxon rank sum test.
Multivariate logistic regression to assess the odds of complication, controlling for co-morbid and operative conditions. We compared different wound classifications, using clean wounds as a reference. We assessed for collinearity between comorbidities by testing for variance inflation factors on linear regression.
Results:
Over the study period, 46,368 children underwent abdominal surgery, including 7752 (16.7%) with a congenital malformation. Children with CM were more likely to have other pre-existing comorbidities, including cardiac risk factors (32.5% vs 6.6% of patients without CM, P<0.0001) and structural pulmonary disease (15.6% vs 2.3%, P<0.0001).
Patients with CM had a longer median hospital length of stay (median 3 days, interquartile range [IQR] 1-14, as compared with median 2 days, IQR 1-4, P<0.0001). The majority of patients, (59.0%) underwent urgent or emergent procedures, while patients with CM were more likely to undergo elective procedures (70.2%, P<0.0001).
On univariate analysis, the presence of a CM was associated with all complications. For instance, patients with CM had 1.9 the odds of readmission (CI 1.7-2.1, P<0.0001) and 2.7 the odds of wound dehiscence (CI 2.0-3.6, P<0.0001).
On multivariate logistic regression, the presence of a congenital malformation was a strong predictor of several complications, from urinary tract infection (P=0.01), post-operative sepsis (P=0.0002), need for reoperation during index stay (P<0.0001), and hospital readmission (P=0.0003, Table). There was no collinearity, allowing for complete analysis of complications.
However, even after controlling for surgical contamination and other risk factors, there was no correlation between the presence of a congenital malformation and superficial wound infection (P=0.16), deep space infection (P=0.76), or post-operative bleeding episode (P=0.10).
Conclusion:There was no increased postoperative risk conferred by CM for many important outcomes, such as bleeding and wound infection. Future work will focus on the risks associated with individual malformations, to further aid in preoperative risk assessment and family discussions.
