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

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.

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