PD38-01 PREDICTING POSTOPERATIVE COMPLICATIONS IN PEDIATRIC SURGERY: A NOVEL COMORBIDITY INDEX FOR PATIENT RISK STRATIFICATION

Abstract

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD38)1 Sep 2021PD38-01 PREDICTING POSTOPERATIVE COMPLICATIONS IN PEDIATRIC SURGERY: A NOVEL COMORBIDITY INDEX FOR PATIENT RISK STRATIFICATION Rohit Tejwani, Hui-Jie Lee, Taylor L. Hughes, Kevin T. Hobbs, Charles D. Scales, and Jonathan C. Routh Rohit TejwaniRohit Tejwani More articles by this author , Hui-Jie LeeHui-Jie Lee More articles by this author , Taylor L. HughesTaylor L. Hughes More articles by this author , Kevin T. HobbsKevin T. Hobbs More articles by this author , Charles D. ScalesCharles D. Scales More articles by this author , and Jonathan C. RouthJonathan C. Routh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002048.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preoperative comorbidity influences postoperative outcomes. Comorbidity-driven surgical risk assessment is essential for informed counseling, risk stratification, and clinical research. Existing mortality-focused indices have mixed success at risk-adjustment in children, where mortality is relatively rare compared to adults. Postoperative complications may serve as a better marker of surgical risk. We sought to develop a new multispecialty risk index predicting 30-day postoperative complications in children. METHODS: Children who underwent surgeries from 1/2014 to 9/2015 were identified using MarketScan® Research databases. Retrospective review identified preexisting comorbidities and 30-day postoperative complications using ICD-9/10-CM codes. The risk index was derived separately for ambulatory and inpatient surgical patients using logistic regression with backward selection. We compared the performance of the novel index in discriminating postoperative complications vis-à-vis 3 existing comorbidity indices using bootstrapping and area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: We identified 293,212 patients (190,629 ambulatory, 22,633 inpatient). The inpatient cohort was older (median 10 vs. 6 years), with higher rates of general surgery procedures (43.5% vs. 17.2%) and pre-existing medical comorbidities, compared to ambulatory patients. The novel index had the best performance for discriminating postoperative complications for inpatients (AUC 0.76, 95% CI 0.75- 0.77) relative to the Charlson Comorbidity Index (CCI, 0.56, 0.56 - 0.57), Van Walraven Index (VWI, 0.60, 0.60 - 0.61), and Rhee Score (RS, 0.69, 0.68 - 0.70). In the ambulatory cohort, the novel index outperformed existing indices, though none was ideal (novel score 0.68, 0.67 - 0.68; CCI 0.53, 0.52 - 0.53; VWI 0.53, 0.52 - 0.53; RS 0.50, 0.49 - 0.50). CONCLUSIONS: In both inpatient and ambulatory settings, our novel pediatric comorbidity index demonstrated better performance at predicting postoperative complications than 3 widely used comorbidity indices. This index can be used for risk adjustment for surgical outcomes in pediatric health services research and may be adaptable to clinical settings to facilitate identification of high risk surgical patients. Source of Funding: Authors acknowledge support of SCORES and BERD groups at our institution in supporting and funding this work. Research reported was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e661-e661 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Tejwani More articles by this author Hui-Jie Lee More articles by this author Taylor L. Hughes More articles by this author Kevin T. Hobbs More articles by this author Charles D. Scales More articles by this author Jonathan C. Routh More articles by this author Expand All Advertisement Loading ...