Unreported deaths in pediatric surgery and anesthesia: a national, twenty year report

Alessandro Putzu ,V Camarda ,Edoardo Calderini ,Giovanni Landoni

doi:10.22514/sv121.102016.17

Abstract

Introduction. Pediatric perioperative mor-tality is extremely low but it is underre-ported in peer-reviewed journals, making it difficult to understand the magnitude of the problem. The aim of this study was to identify pediatric deaths reported by the mass media over a 20- year period in pedi-atric and non-pediatric hospitals.Materials and methods. The international search engines Google, Yahoo, Bing, and the online archives of major newspapers were searched independently by 3 trained investigators (1st January 1995 to 1st Janu-ary 2015) looking for children (<18 years old) who died in the perioperative period in Italy, excluding obstetrical or neonatal deaths.Results. A total of 51 fatal events were identified with 41 cases (80%) being elec-tive procedures. Most fatal events (31 cases, 61%) occurred in non-specialized hospi-tals, 12 cases (23%) occurred in high-vol-ume non-pediatric hospitals, and 8 cases (16%) in pediatric hospitals. The most fre-quently represented operations were head/neck 21 cases (41%), abdominal 11 cases (21%), and orthopedic surgery 9 cases (18%). The reported causes of death were equally distributed between surgical (25 cases, 49%) and anesthesiological compli-cations. The most common causes of death were hemorrhage (n=11), difficult airway management (n=10), infections (n=6), and allergic reactions (n=4). In 25% of cases (13 cases), the complication resulted in intra-operative death.Conclusion. Our findings suggest that most pediatric deaths reported by mass media occurred in non-pediatric centers during elective surgical procedures (e.g. adenotonsillectomy and appendicectomy), suggesting that referral to large-volume or pediatric hospitals should be preferred. Moreover, one of the most commonly re-ported complications was difficult airway management, confirming that this aspect should have a central role in physician training and practice.

Highlights

Pediatric perioperative mortality is extremely low but it is underreported in peer-reviewed journals, making it difficult to understand the magnitude of the problem
Our findings suggest that most pediatric deaths reported by mass media occurred in non-pediatric centers during elective surgical procedures, suggesting that referral to large-volume or pediatric hospitals should be preferred
(5) our findings suggest that this figure could be further reduced since: a) most unexpected deaths occurred in elective surgery children operated in non-specialized hospitals; and b) difficult airway management was the most common anesthesiological complication and it is often related to lack of specific pediatric expertise

Summary

Introduction

Pediatric perioperative mortality is extremely low but it is underreported in peer-reviewed journals, making it difficult to understand the magnitude of the problem. The aim of this study was to identify pediatric deaths reported by the mass media over a 20- year period in pediatric and non-pediatric hospitals. [3] Few case reports or case series of pediatric perioperative mortality reach the publication level in peer-reviewed journals, making it hard to understand the impact of the problem. Reports of these unfortunate events have a massive media resonance due to the susceptibility of the general population to the topic, when fatal complications occur during an elective or low-risk procedure in otherwise healthy children. The aim of this study was to identify all the perioperative pediatric deaths reported by the mass media in recent years in Italy and to report the occurrence in pediatric and non-pediatric specialized hospitals

Objectives

Methods

Results

Conclusion