Key result
Delay to emergent surgery of more than 60 minutes was associated with an 85% increased odds of major morbidity and/or mortality in children compared to no delay (adjusted OR 1.85).
Why the study?
Delay of emergency surgery contributes to morbidity and mortality, but whether delays to emergent surgery in children are associated with increased major morbidity or mortality in a risk-adjusted population remained to be determined.
Does delay to emergent surgery increase major morbidity and/or mortality in children requiring class 1 emergent surgery?
Cohort (n=367)
No
Does delay to emergent surgery increase major morbidity and/or mortality in children requiring class 1 emergent surgery?
Delay to emergent surgery in children is associated with a significant increase in major morbidity and mortality, highlighting the need for prioritized access to operating rooms.
Background: Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population. Methods: We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children’s Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ2 test for univariate analysis and logistic regression for multivariate analysis. Results: There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d–18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20–2.94) compared to no delay. Conclusion: Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.
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Butterworth et al. (2023) conducted a cohort in Emergent surgical conditions in children (n=367). Delay to surgery (>60 minutes from booking to in room) vs. No delay (≤60 minutes) was evaluated on Major morbidity and/or mortality (adjusted OR 1.85, 95% CI 1.20-2.94). Delay to emergent surgery of more than 60 minutes was associated with an 85% increased odds of major morbidity and/or mortality in children compared to no delay (adjusted OR 1.85).
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