Pediatric elective therapeutic procedure complications: A multicenter cohort analysis.
BACKGROUND AND AIM: Current understanding of specific, therapeutic procedure-associated complications in pediatric patients remains limited. This study aims to determine the frequency of significant complications in pediatric age-range subjects following the principal therapeutic endoscopic procedures.
METHODS: This study used retrospective multi-institutional, ICD-9-CM, Clinical Transaction Classification, and Current Procedural Terminology based database (Pediatric Hospital Information System) analysis. This study included demographic, chronic comorbidity, procedure type, and post-procedure outcomes defined through mortality, unplanned direct admission, emergency room, and inpatient admission and inpatient therapeutic events.
RESULTS: During the study period, 18 018 patients underwent therapeutic endoscopy; 132 required direct (0.16%) or emergency room/inpatient (0.58%) admission within 5 days following the procedure; mortality was 0.01%. Most (50.75%) complications presented on the day of or 1 day post-procedure. Hispanic race and coexisting chronic comorbidities, especially gastrointestinal conditions, were identified risk factors for significant complications. Endoscopic dilatation and variceal ablation were most frequently associated with complications. Abdominal pain, gastrointestinal bleeding, and esophageal stricture were the most common diagnoses: 9.0% required intravenous antibiotics, 36.63% underwent chest imaging, 27.27% abdominal imaging, and 0.75% required blood transfusion. Readmission following esophageal dilatation was most likely to result in prolonged admission.
CONCLUSION: In the pediatric population undergoing therapeutic endoscopy in the ambulatory setting, significant postoperative complications resulting in unplanned admission are rare. Complications can be anticipated in medically frail patients especially with gastrointestinal chronic illness. Procedures involving variceal ablation and esophageal dilatation entail the highest risk.
Journal of gastroenterology and hepatology
Age Distribution; Comorbidity; Elective Surgical Procedures; Endoscopy; Frailty; Gastrointestinal Diseases; Hispanic Americans; Humans; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
bleeding; comorbidity; demography; dilatation; endoscopy; esophageal stenosis; patient readmission; pediatric; postoperative complications; therapeutic endoscopy
Attard TM, Miller M, Walker AA, Lee B, McGuire SR, Thomson M. Pediatric elective therapeutic procedure complications: A multicenter cohort analysis. J Gastroenterol Hepatol. 2019;34(9):1533-1539. doi:10.1111/jgh.14626