Nasr et al evaluate pediatric patients prior to surgery. Surgical risk depends on a combination of both patient comorbidities and the intrinsic surgical risk. The authors are from Boston Children's Hospital.
Patient selection: pediatric patient prior to surgery
Outcome for study: 30-day mortality
Risk factors for mortality:
(1) body weight < 5 kg (OR 1.56)
(2) ASA III or higher (OR 17.6 for ASA III; 69.4 for ASA IV; 296.7 for ASA V)
(3) sepsis (OR 2.1)
(4) need for inotropic support (OR 2.9)
(5) ventilator dependence (OR 2.6)
(6) high intrinsic surgical risk (OR 4.4 for CPT risk quartile 3 and 7.9 for risk quartile 4)
Number of Risk Factors
30-Day Mortality for Low Intrinsic Surgical Risk
30-Day Mortality for High Intrinsic Surgical Risk
0
0%
0.05%
1
0.04%
0.45%
2
0.12%
1.5%
3
0.59%
6.6%
4
2.2%
21%
5
5.2%
39.3%
where:
• The ASA status alone outweighs the other risk factors, especially for ASA 4 and 5.
• The mortality risk appears about 10 times greater for high risk than low risk surgery.
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