D. Ji1, S. L. Goudy2, M. V. Raval3, N. P. Raol2 1Mercer University School Of Medicine,Savannah, GA, USA 2Emory University School Of Medicine, Children’s Healthcare Of Atlanta,Division Of Pediatric Otolaryngology, Department Of Otolaryngology – Head And Neck Surgery,Atlanta, GA, USA 3Emory University School Of Medicine, Children’s Healthcare Of Atlanta,Division Of Pediatric Surgery, Department Of Surgery,Atlanta, GA, USA
Introduction: Currently used pediatric surgical risk assessment tools use patient and procedure-specific variables to predict postoperative complications following specific procedures. These tools assist clinicians in preoperative counseling and surgical decision-making. The objective of this systematic literature review was to compile and evaluate current pediatric surgical risk scores that are applicable across pediatric surgical specialties.
Methods: A systematic literature review was performed following PRISMA guidelines to identify relevant publications. Studies were independently screened by two reviewers by pre-defined eligibility criteria. Data was extracted from the selected manuscripts and the included articles were assessed for quality and risk of bias using the Newcastle-Ottawa Scale. Studies were included if they met the following criteria: designed to develop a preoperative risk model predicting postoperative complications or mortality, applicable across various surgical specialties, and pertinent to the pediatric population. Studies with specialty- or procedure-specific risk scores and validation studies were excluded.
Results: Of 19 studies identified on initial title and abstract review, 4 studies (21%) comprising of 2,352,481 patients met inclusion criteria. Each study reported assessment of a novel, generally applicable pediatric surgical risk score to risk stratify children preoperatively. Risk variables evaluated across the models reflected the degree of resilience or fragility of the patient prior to surgery. Risk factors common to all studies were the presence of cardiovascular or neurological diseases. Three of the four included studies defined most risk factors in binary terms, whereas one study used a scale of severity of organ system disease when defining preoperative risk. Generated risk scores positively correlated with inpatient mortality or postoperative complications, with c-statistic values ranging from 0.77-0.98.
Conclusion: Though a variety of risk assessment tools are available to reliably inform adverse events for children undergoing surgery, many of the characteristic risk factors were addressed in binary terms, limiting capture of differences in risk across gradients of preoperative condition and fragility. More study is needed to assess generalizability in all populations and procedures.