Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

Abstract


Introduction
Postoperative outcome in surgical patients is an important issue in our daily practice.
Predictors of postoperative outcome are multifactorial among which American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age were identi ed in previous studies (1,2,3,4).Predictors of postoperative outcome in this study were not exhaustive which means that other non-identi ed factors may contribute in how patients evolve after surgery.
For a better postoperative outcome, anticipating patient's management optimization begins preoperatively, continues intra-operatively and postoperatively.Intra-operative patient optimization includes uid and hemodynamic goal directed therapy with tools validated in children, blood patient transfusion protocols guided with point of care tests in hemorrhagic surgery and enhanced recovery after surgery protocols (5,6,7,8,9,10,11,12,13).These goal directed therapies have been shown in adults to improve postoperative outcome.In children, goal directed therapies are not well developed and are not in routine generalized practice.
The study presented here had the objective to describe postoperative outcome in children aged between 6 and 10 years who were included in the initial retrospective study (1).The aim was to emphasize how these patients in major surgery evolved and to propose improvement implementation protocols.

Methods And Materials
Secondary analysis of children between 6 and 10 years old included in the initial study (1).
The study was declared to the CNIL, National Commission for Computer Science and Liberties on 21 February 2017 under the registration number 2028257 v0.The Ethics Committee of Necker approved the study on 21 March 2017 under the registration number 2017-CK-5-R1.
Patients were included retrospectively from 1 January 2014 to 17 May 2017.
Inclusion criteria were children aged between 6 and 10 years old.
Exclusion criteria were children aged less than 6 years old and older than 10 years.
Statistics were analyzed with XLSTAT 2020.4.1 software.
Continuous variables were described in means ± standard deviation or medians with interquartile ranges.Categorial variables were described in proportions.

Discussion And Conclusion
The rate of patients with intra-operative and or postoperative complications in this cohort of 88 children between 6 and 10 years in major abdominal surgery, neurosurgery and orthopedics was 25%.These patients were in majority ASA grade 3 or more.As revealed in the initial studies (1, 2, 3, 4) postoperative outcome depends on multiple factors precisely ASA status, transfusion, age, emergency and surgery.
Integrating goal directed therapies for intra-operative management these patients is a necessary implementation to improve postoperative outcome in pediatric surgical patients.Goal therapies include intra-operative uid and goal therapy validated tools in children, intra-operative transfusion goal directed protocols with point of care devices to guide blood product administration and enhanced recovery after surgery (5,6,7,8,9,10,11,12,13).All these therapies have the same aim which is to optimize intra-operative patient status which contributes to a favorable postoperative evolution.In our Hospital, goal directed therapies are not yet a routine generalized practice.It is time to reconsider integrating goal directed therapies in intra-operative patient management in high risk patients and surgery to improve postoperative outcome.