Association between index complication and outcomes after inpatient pediatric surgery

Jorge I. Portuondo*, Steven C. Mehl, Sohail R. Shah, Mehul V. Raval, Huirong Zhu, Sara C. Fallon, David E. Wesson, Nader N. Massarweh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: A cascade of complications is believed to be the primary mechanism underlying failure to rescue (FTR), or death of a patient after a postoperative complication. It is unknown whether specific types of index complications are associated with the incidence of secondary complications and FTR after pediatric surgery. Methods: National cohort study of patients within the National Surgical Quality Improvement Program–Pediatric database who underwent inpatient surgery (2012–2019). Index complications were grouped into nine categories (cardiovascular, venous thromboembolism, pulmonary, bleeding/transfusion, renal, central nervous system, wound, infectious, or minor [defined as having an associated mortality rate <1%]). The association between the type of index complication with FTR, secondary complications, reoperation, unplanned readmission, and postoperative length of stay was evaluated with multivariable logistic regression and generalized linear modeling. Results: Among 425,386 patients, 15.5% had at least one complication, 16.6% had one or more secondary complications, 13.9% reoperation, 14.5% readmission, and 2.4% FTR. Secondary complication (10.8–59.7%) and FTR (0.3–31.1%) rates varied by type of index complication. Relative to patients who had an index minor complication, those with an index infectious complication were most likely to have secondary complication (Odds Ratio [OR] 10.3, 95% CI [9.36–11.4]). Index CV complications were most strongly associated with FTR (OR 30.7 [24.0–39.4]). Index wound complications had the greatest association with reoperation (OR 21.9 [20.5–23.4]) and readmission (OR 18.7 [17.6–19.9]). Index pulmonary complications had the strongest association with length of stay (coefficient 9.39 [8.95–9.83]). Conclusions: Different types of index complications are associated with different perioperative outcomes. These data can help identify patients potentially at risk for suboptimal outcomes and can inform pediatric quality improvement interventions. Type of study: Cohort study. Level of evidence: Level II.

Original languageEnglish (US)
JournalJournal of pediatric surgery
StateAccepted/In press - 2022


  • Complications
  • Failure to rescue
  • Length of stay
  • Pediatric surgery
  • Readmission
  • Reoperation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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