Identifying Early Predictive Factors of Unexpected Clinical Deterioration in Postoperative Pediatric Surgical Patients.

BACKGROUND Postoperative patients are at a higher risk for unexpected clinical changes in the immediate postoperative period that may necessitate escalation of care.

OBJECTIVE The study aimed to identify the characteristics, triggers, potential risk factors, and outcomes associated with clinical deterioration necessitating rapid response (RR) activation in post-surgical patients.

METHODS A 5-year retrospective review was performed at a large tertiary academic hospital of clinical characteristics and outcomes of postoperative pediatric surgical patients admitted to the ward who had a RR within 30 days after surgery. The study utilized the National Surgical Quality Improvement Program (NSQUIP) calculator as a predictor tool to compare individual patients' risk to the average population risk.

RESULTS Of the 435 surgical patients, the predominant reasons for RR activation were: multisystem 136 (34.1%) and respiratory 114 (28.6%). Two hundred thirty-eight (55.7%) were elective cases, and the most common surgical category was otolaryngology, 55 (12.8%). Patient comorbidities included: developmental delay (135, 31.5%) and cardiac anomalies (102, 23.8%). After RR, transfer to the PICU occurred in 248 events (57%); 63.7% (158) required intravenous fluid therapy, 19.8% (47) required mechanical ventilation within 24 hours, and 46 (12.3%) underwent reoperation. The median PICU length of stay (LOS) was 2 days (IQR: 0.0, 7.0), and mortality of 23 (5.9%). This patient cohort had a higher NSQUIP risk for any complications, pneumonia, surgical site infection, venous thrombosis, renal failure, and reintubation versus the average population risk.

CONCLUSIONS Postoperative RR activation with PICU transfer is associated with longer LOS, higher rate of reoperation, and higher mortality. The NSQUIP predictor tool should be explored further to guide postoperative clinical management and resource allocation for future surgical patients.