OBJECTIVE: To develop a risk-adjustment method for evaluation of in-hospital mortality after noncardiac neonatal surgery regardless of gestational age.
METHODS: Infants ≤30 days old undergoing noncardiac surgical procedures were identified by using the Kids’ Inpatient Database (KID) 2000 + 2003. Neonates were included regardless of gestational age. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to assign procedures to 1 of 4 previously derived risk categories. Prematurity and other clinical variables were assessed in logistic regression analysis. The final multivariable model was validated in 3 independent data sets: KID 2006, Pediatric Health Information System (PHIS) 2001–2003, and PHIS 2006–2008. The model was applied to generate standardized mortality ratios for institutions within PHIS 2006–2008.
RESULTS: Among 18 437 eligible cases in KID 2000 + 2003, 15 278 (83%) had 1 of 66 procedure codes assigned to a risk category and were eligible for analysis. In-hospital mortality for premature infants was 10.5% compared with 2.0% for full-term neonates. In addition to risk category, the clinical variables improving prediction of in-hospital death were prematurity, serious respiratory conditions, necrotizing enterocolitis, neonatal sepsis, and congenital heart disease. Area under the receiver-operator characteristic curve for the final model was 0.90. The model also showed excellent discrimination in the 3 validation data sets (0.90, 0.89, and 0.89). Within 41 institutions in PHIS, standardized mortality ratios ranged from 0.37 to 1.91.
CONCLUSIONS: This validated method provides a tool for risk adjustment of neonates undergoing noncardiac surgery to allow comparative analyses of in-hospital mortality.
- CHD —
- congenital heart disease
- CI —
- confidence interval
- ICD-9-CM —
- International Classification of Disease, Ninth Revision, Clinical Modification
- KID —
- Kids’ Inpatient Database
- NEC —
- necrotizing enterocolitis
- OR —
- odds ratio
- PHIS —
- Pediatric Health Information System
- ROC —
- receiver-operator characteristic
- SMR —
- standardized mortality ratio
- Accepted May 10, 2012.
- Copyright © 2012 by the American Academy of Pediatrics