Research Article
Volume 10 Issue 6 - 2021
Children Aged between 1 and 3 Years in Non-Cardiac Surgery and Postoperative Outcome
Claudine Kumba*
Department of Pediatric and Obstetric Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, APHP, Université de Paris, Paris, France
*Corresponding Author: Claudine Kumba, Department of Pediatric and Obstetric Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, APHP, Université de Paris, Paris, France.
Received: May 10, 2021; Published: May 28, 2021




Abstract

Background: An observational study conducted previously to determine predictors of postoperative outcome in pediatric abdominal surgery, orthopedics and neurosurgery revealed that factors which influenced postoperative evolution were multiple. These included American Society of Anesthesiologists (ASA) score, transfusion, age, emergency surgery and surgery.

Objectives: To describe outcomes in children aged between 1 and 3 years old included in the initial study.

Methods: Secondary analysis of the initial retrospective observational study in 594 patients with a mean age of 90.86 ± 71.80 months. The study was approved by the Ethics Committee under the registration number 2017-CK-5-R1.

Results: There were 79 children with a mean age of 22.04 ± 7.15 months. The majority of the patients (36.71%) were American Society of Anesthesiologists (ASA) grade 3. There were 37 neurosurgical (46.83%), 34 abdominal surgical (43.04%) and 8 orthopedic patients (10.13%).

The most common interventions were craniosynostosis in 16 patients (20.25%), intestinal resection in 13 patients (16.45%), intracerebral tumor resection in 7 patients (8.86%), neuroblastoma in 5 patients (6.30%), liver transplantation in 3 patients (3.79%) and renal transplantation in 2 patients (2.53%).

20 patients (25.32%) had intra-operative and or postoperative complications. 4 patients (5.06%) had re-operations. 2 patients (2.53%) had intra-operative broncho-laryngospasm. 3 (3.78%) patients had intra-operative hemorrhagic shock. 6 (7.59%) patients had cardio-circulatory failure. 4 (5.04%) had neurologic failure. 1.27% of the patients had postoperative hepatic failure (1 patient), postoperative multiple organ failure (1 patient), postoperative respiratory failure (1 patient), postoperative renal failure (1 patient). The most common postoperative infections were septicemia in 5 patients (6.33%), pulmonary sepsis in 3 patients (3.79%), abdominal sepsis in 1 patient (1.27%) and surgical wound sepsis in 1 patient (1.27%).

46 patients (58.23%) had intra-operative transfusion.

The rate of in-hospital mortality was 2.53% (2 patients).

Conclusion: 25% of the patients in this cohort had intra-operative and or postoperative complications. Outcome in surgical patients is multifactorial. Integrating goal directed therapies to optimize intra-operative patient management is one of the major keys to improve postoperative outcome in surgical patients.

Keywords: Children Aged between 1 and 3 Years; Non-Cardiac Surgery; Postoperative Outcome

References

  1. Kumba C., et al. “Transfusion and Morbi-Mortality Factors: An Observational Descriptive Retrospective Pediatric Cohort Study”. Journal of Anesthesia and Critical Care: Open Access4 (2017): 00315.
  2. Kumba C., et al. “A Systematic Review and Meta-analysis of Goal Directed Intra-Operative Transfusion Protocols Guided by Viscoelastic Methods and Perioperative Outcomes in Children”. International Journal of Recent Scientific Research 3 (2019): 31466-31471.
  3. Disma N., et al. “Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)”. British Journal of Anaesthesia (2021).
  4. Kumba C. “Physiology Principles Underlying Goal Directed Therapies in Children”. Research Pediatric Neonatology4 (2020): 000591.
  5. Kumba C. “Rationale of Goal Directed Therapies in Children”. Advances in Pediatric Research 7 (2020): 42.
  6. Kumba C. “Do Goal Directed Therapies Improve Postoperative Outcome in Children? (Perioperative Goal Directed Fluid and Hemodynamic Therapy; Transfusion goal directed therapy using viscoelastic methods and enhanced recovery after surgery and Postoperative outcome): A Study Research Protocol”. Acta Scientific Paediatrics7 (2019): 17-19.
  7. Kumba C. “Goal directed fluid and hemodynamic therapy and postoperative outcomes in children: Value of transthoracic echocardiographic aortic blood flow peak velocity variation: A multi-centre randomized controlled trial protocol”. Advances in Pediatric Research 7 (2020): 35.
  8. Kumba C. “Trans-Thoracic Echocardiographic Aortic Blood Flow Peak Velocity Variation, Distance Minute, Aortic Velocity Time Integral and Postoperative Outcome in Pediatric Surgical Patients-An Observational Pilot Study Protocol”. Open Journal of Internal Medicine 10 (2020): 90-95.
  9. Kumba C., et al. “A Systematic Review and Meta- Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome”. The Journal of Emergency and Critical Care Medicine1 (2019): 1-9.
  10. Kumba C., et al. “Rapid Recovery Pathways after Surgery in Children: A Systematic Review and Meta-Analysis”. Medical Journal of Clinical trials and Case Studies3 (2019): 000211.
  11. Kumba C and Melot C. “The Era of Goal Directed Therapies in Paediatric Anaesthesia and Critical Care”. EC Emergency Medicine and Critical Care5 (2019): 306-309.
  12. Chen CC., et al. “Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury”. Brain Science 11 (2021): 136.
  13. Hankinson TC and Dudley RW. “"Short-term mortality following surgical" procedures for the diagnosis of pediatric brain tumors: outcome analysis in 5533 children from SEER, 2004–2011”. Journal of Neurosurgery: Pediatrics 17 (2016): 289-297.
Citation: Claudine Kumba. “Children Aged between 1 and 3 Years in Non-Cardiac Surgery and Postoperative Outcome”. EC Paediatrics 10.6 (2021): 67-74.

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