M. A. Bartz-Kurycki1,2, K. T. Anderson1,2, M. T. Austin1,2, L. S. Kao1, K. Tsao1,2, K. P. Lally1,2, A. L. Kawaguchi1,2 1McGovern Medical School, University Of Texas Health Sciences Center At Houston,Pediatric Surgery,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Houston, TX, USA
Introduction: Down syndrome (DS) is associated with multiple co-morbidities, which may increase the risk of post-operative complications. Physicians perceive that DS patients have a higher risk of post-operative complications; however, the literature remains unclear. This study evaluated the risk of post-surgical complications for abdominal and thoracic procedures in children with and without DS.
Methods: The National Surgical Quality Improvement Program Pediatric (NSQIP-P) database was queried for patients under 18 years of age who underwent non-cardiac abdominal and thoracic operations (by CPT codes) between 2012 and 2016. Analysis compared patients based on the presence or absence of DS. The primary outcome was a composite of all post-operative complications as defined by NSQIP-P. Analysis utilized chi square, student’s t-test, and univariate and multivariate logistic regression. Potential pre-operative risk factors, including DS and those found in the NSQIP-P risk calculator, were evaluated for an association with post-operative complications. Variables were tested for interactions.
Results: 91,478 surgical patients were included with a mean age of 7.2 years ± 6.1 years. Of those patients, 57.8% were male and 1,476 (1.6%) had a diagnosis of DS. Baseline covariates demonstrated significant differences; patients with DS had higher rates of pre-operative nutritional support (38.8% vs. 15.0%), developmental delay (61.9% vs. 10.4%), and cardiac risk factors (76.5% vs 13.8%). The overall rate of post-operative complications was 10.9% and patients with DS demonstrated a higher proportion than controls (16.2% vs 10.8%, p<0.001). On univariate analysis, DS was associated with increased odds of post-operative complications (OR 1.6 95%CI 1.4-1.9) compared to the non-DS group; however, this risk was reversed when adjusting for all other covariates (aOR 0.86 95%CI 0.7-1.1; Table). Univariate analysis of individual surgical complications suggested an increased risk of sepsis (2.6 95%CI 1.8-3.6) and surgical site infection associated with DS (OR 1.6 95%CI 1.3-2.0) but were not statistically significant on multivariate analysis.
Conclusion: Although a greater proportion of post-operative complications were observed in patients with DS, when adjusting for other risk factors, DS was not an independent risk factor. The increased rate of complications is likely related to the presence of certain risk factors that are more common in DS, such as hematologic disorders, cardiac risk factors, nutritional supplementation, and ventilator dependence. Pre-operative counseling and optimization for patients with DS should be tailored to the individual based on their co-morbidities.
