Unreported deaths in pediatric surgery and anesthesia: a national, twenty year report
1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
2 Department of Anesthesia, Intensive Care, and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
DOI: 10.22514/SV121.102016.17 Vol.12,Issue S1,October 2016 pp.101-105
Published: 10 October 2016
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.
ALESSANDRO PUTZU,EDOARDO CALDERINI,VALENTINA CAMARDA,GIOVANNI LANDONI. Unreported deaths in pediatric surgery and anesthesia: a national, twenty year report. Signa Vitae. 2016. 12(S1);101-105.
1. Tzong KYS, Han S, Roh A, Ing C. Epidemiology of pediatric surgical admissions in US children: data from the HCUP kids inpatient database. J Neurosurg Anesthesiol 2012;24:391–5. doi:10.1097/ANA.0b013e31826a0345.
2. Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013;132:e1466–72. doi:10.1542/peds.2013-1243.
3. Abdullah F, Gabre-Kidan A, Zhang Y, Sharpe L, Chang DC. Report of 2,087,915 surgical admissions in U.S. children: inpatient mor-tality rates by procedure and specialty. World J Surg 2009;33:2714–21. doi:10.1007/s00268-009-0219-8.
4. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet (London, England) 2012;380:1059–65. doi:10.1016/S0140-6736(12)61148-9.
5. Italian Ministry of Health. Le caratteristiche dell’ospedalizzazione pediatrica in Italia (dal neonato all’adolescente). Ital Natl Inst Stat (Website) 2005. (accessed November 23, 2015). Available from: http://www.salute.gov.it/portale/documentazione/p6_2_2_1. jsp?lingua=italiano&id=999 .
6. Head R, Murray J, Sarrassat S, Snell W, Meda N, Ouedraogo M, et al. Can mass media interventions reduce child mortality? Lancet 2015;386:97–100. doi:10.1016/S0140-6736(14)61649-4.
7. Yoo B-K, Holland ML, Bhattacharya J, Phelps CE, Szilagyi PG. Effects of mass media coverage on timing and annual receipt of influ-enza vaccination among Medicare elderly. Health Serv Res 2010;45:1287–309. doi:10.1111/j.1475-6773.2010.01127.x.
8. Lee HH, Milgrom P, Starks H, Burke W. Trends in death associated with pediatric dental sedation and general anesthesia. Paediatr Anaesth 2013;23:741–6. doi:10.1111/pan.12210.
9. Holtzman NA, Bernhardt BA, Mountcastle-Shah E, Rodgers JE, Tambor E, Geller G. The quality of media reports on discoveries related to human genetic diseases. Community Genet 2005;8:133–44. doi:10.1159/000086756.
10. DiMaggio C, Sun LS, Ing C, Li G. Pediatric anesthesia and neurodevelopmental impairments: a Bayesian meta-analysis. J Neurosurg Anesthesiol 2012;24:376–81. doi:10.1097/ANA.0b013e31826a038d.
11. Wang X, Xu Z, Miao C-H. Current clinical evidence on the effect of general anesthesia on neurodevelopment in children: an updated systematic review with meta-regression. PLoS One 2014;9:e85760. doi:10.1371/journal.pone.0085760.
12. Sheeran PW, Walsh BK, Finley AM, Martin AK, Brenski AC. Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital. Paediatr Anaesth 2014;24:819–24. doi:10.1111/pan.12356.
13. Calder A, Hegarty M, Davies K, von Ungern-Sternberg BS. The difficult airway trolley in pediatric anesthesia: an international survey of experience and training. Paediatr Anaesth 2012;22:1150–4. doi:10.1111/pan.12058.
14. Gonzalez LP, Pignaton W, Kusano PS, Módolo NSP, Braz JRC, Braz LG. Anesthesia-related mortality in pediatric patients: a system-atic review. Clinics (Sao Paulo) 2012;67:381–7.
15. Mir Ghassemi A, Neira V, Ufholz L-A, Barrowman N, Mulla J, Bradbury CL, et al. A systematic review and meta-analysis of acute severe complications of pediatric anesthesia. Paediatr Anaesth 2015;25:1093–102. doi:10.1111/pan.12751.
16. Evans C, van Woerden HC. The effect of surgical training and hospital characteristics on patient outcomes after pediatric surgery: a systematic review. J Pediatr Surg 2011;46:2119–27. doi:10.1016/j.jpedsurg.2011.06.033.
17. Auroy Y, Ecoffey C, Messiah A, Rouvier B. Relationship between complications of pediatric anesthesia and volume of pediatric an-esthetics. Anesth Analg 1997;84:234–5.
18. Healy DA, Doyle D, Moynagh E, Maguire M, Ahmed I, Ahmed AS, et al. Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children. Medicine (Baltimore) 2015;94:e1352. doi:10.1097/MD. 0000000000001352.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.