Prediction of peri-operative mortality in care of preterm children in non-cardiac surgery

Background The aim of this study was to develop a risk calculation model for peri-operative 30-day-mortality in preterm infants in non-cardiac surgery. Methods Retrospective monocentric follow-up cohort-study of 27,453 pediatric anesthesias at a German university hospital and level one perinatal cen...

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Veröffentlicht in:BMC anesthesiology Jg. 25; H. 1; S. 296 - 11
Hauptverfasser: Jansen, Gerrit, Irmscher, Linda, Jagoda, Sunil, Hinkelbein, Jochen, May, Theodor W., Popp, Jakob, Rehberg, Sebastian
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 19.06.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Age
Analysis
Anesthesia
Anesthesiology
Birth weight
Body weight
Cardiac arrest
Catecholamines
Child
Classification
Congenital
Critical Care Medicine
Death
Dopamine
Emergency Medicine
Health aspects
Heart
Infants
Infants (Premature)
Intensive
Internal Medicine
Laparotomy
Lungs
Medicine
Medicine & Public Health
Menstruation
Mortality
Neonates
Nervous system
Newborn babies
Norepinephrine
Ostomy
Paediatric
Pediatric anesthesia
Pediatrics
Prediction models
Premature babies
Premature birth
Prematurity
Regression analysis
Review boards
Risk assessment
Risk factors
Sepsis
Statistical analysis
Surgery
Taiwan
Taiwan
New York
United States > US
Germany
Paediatric
Death
Congenital
Prematurity
Child
ISSN:1471-2253, 1471-2253
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Zusammenfassung:Background The aim of this study was to develop a risk calculation model for peri-operative 30-day-mortality in preterm infants in non-cardiac surgery. Methods Retrospective monocentric follow-up cohort-study of 27,453 pediatric anesthesias at a German university hospital and level one perinatal center between 2008 and 2021 for non-cardiac surgeries. Inclusion criteria were age < 37 post-menstrual weeks at the time of surgery. The primary endpoint was 30-day-mortality after surgery. For statistical analysis, stepwise backwards logistic regressions were performed to identify predictors for 30-day mortality after surgery. Results Between 2007 and 2021, 278 preterm infants underwent surgery. The 30-day-mortality was 8.6% (24/278; CI95%:5.6–12.6). A preselection of potential risk factors was based primarily on prior knowledge available from the literature and the results of previously published studies. The final prediction model using a multivariable logistic regression revealed lower post-menstrual age (odds-ratio(OR): 0.67; CI95%: 0.54–0.83) and lower body weight at the time of surgery for extremely preterm infants (OR: 0.024; CI95%: 0.003–0.22), administration of dopamine or norepinephrine or epinephrine (OR: 11.6; CI95%: 3.58–37.7), and life-threatening emergencies between 10pm-7am (OR: 10.1; CI95%: 2.36–43.5) as significant independent risk factors for 30-day-mortality. The Area-Under-The-Receiver-Operating-Characteristic-Curve (0.90; CI95%: 0.85–0.96) showed a good discrimination of the final model. The investigation of the calibration curve ( p  = 0.99, Spiegelhalter test) and the goodness of fit test ( p  = 0.85, Hosmer-Lemeshow test) indicated no significant discrepancies between estimated and observed probabilities for the peri-operative 30-day mortality. Conclusions Peri-operative 30-day-mortality of preterm infants during non-cardiac surgery is high. The prediction model with easily ascertainable factors as described could be a valuable tool for estimating 30-day-mortality in preterm infants and should be validated in larger populations.
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ISSN:1471-2253
1471-2253
DOI:10.1186/s12871-025-03168-x