For many of the most common U.S. pediatric operations, the new Pediatric Surgical Risk Calculator provides an individualized estimate of the chance of a young patient experiencing postoperative complications, according to research findings appearing online in the Journal of the American College of Surgeons. The calculator is from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).
“The NSQIP Pediatric Surgical Risk Calculator is the first web-based tool to help surgeons estimate the surgical risk for a pediatric patient across multiple surgical specialties,” said study coauthor Clifford Y. Ko, MD, MS, MSHS, FACS, director of the ACS Division of Research and Optimal Patient Care, which administers ACS NSQIP.
Although ACS NSQIP has offered its popular multispecialty Surgical Risk Calculator for adults since 2013, this new risk assessment tool is designed to give customized surgical risk estimates for patients younger than 18 years of age. It is available to the public.
The NSQIP Pediatric Surgical Risk Calculator can, as part of a discussion with the surgeon, help a young patient’s family make an informed decision about whether to go forward with a planned elective operation or even an emergency procedure, said Ko, who also is a professor of surgery at the University of California–Los Angeles David Geffen School of Medicine.
A pediatric-specific risk calculator is needed because infants and children have different risk factors; may undergo similar procedures as adults do, such as colon operations, for entirely different reasons; and may undergo operations that are unique to the pediatric population, according to co-author Shawn J. Rangel, MD, MSCE, FACS, a pediatric surgeon at Boston Children’s Hospital who chairs the ACS Children’s Surgery Data Committee. Children typically don’t have cardiovascular disease and other chronic medical conditions often associated with adult patients undergoing surgery. However, they may have other serious conditions that are unique to the pediatric population, including prematurity, birth defects, and other conditions that may affect their immune system and ability to heal, he explained.
“Currently pediatric surgeons often must quote surgical risk estimates from data that have been published in the literature, and often this information is markedly outdated and [comes] from single hospitals that are not their own,” Rangel said. “Development of the NSQIP Pediatric Surgical Risk Calculator is an important milestone because it gives pediatric surgeons a tool to be much more precise in estimating a child’s risk of complications.”
Until recently, there were insufficient pediatric data to support a risk calculator for a broad selection of procedures and potentially unfavorable outcomes for children’s surgery, according to Ko. In 2008, the ACS, in collaboration with the American Pediatric Surgical Association, developed a new database, ACS NSQIP Pediatric, so that participating hospitals could collect and share reliable outcomes data specifically for pediatric surgical specialties. Data collection began in 2011.
To create the new risk prediction tool, the investigators used standardized NSQIP Pediatric data between 2012 and 2014, which included 181,353 patient cases from 67 hospitals and 382 standard Current Procedural Terminology codes identifying procedures performed in the United States. Among the procedure codes that NSQIP Pediatric collects, only those that occurred at least 25 times in the dataset were used for this study. Specialties included general surgery, cardiothoracic surgery, neurosurgery, orthopedic surgery, otolaryngology, gynecology, urology, and plastic surgery. The research team reported that each surgical case had a 30-day follow-up for complications.
“NSQIP Pediatric has among the best, if not the best, data available for children’s surgery,” Ko said.
The NSQIP Pediatric Surgical Risk Calculator is available online at http://bit.ly/2dxr8Ci. At press time, the study was to be published in a print edition of the Journal later this year. To access the abstract, go to http://bit.ly/2cRgUyD.