RISK SCORE AND POSTOPERATIVE COMPLICATION S IN PEDIATRIC-SURGERY

We have developed a risk score meeting the special demands of pediatri c surgery. It conveys an objective impression of the patients' preoper ative condition and enables us to predict their individual intra- and postoperative behavior. This study compiles the course of 1425 operati ons carried out between 1986 and 1990. They were divided into low, int ermediate and high risk. In addition, the patients were classified int o six different age groups. We demonstrate that the number of points a ssigned by our risk score is highly correlated with the rate of compli cations that occurred, that accompanying malformations and diseases ar e correctly picked up and weighed by the score as far as their importa nce for the postoperative course is concerned, that the score is suita ble for ascertaining which patients have a high probability of develop ing complications: the specificity is close to 100% for more than 12 p oints on the score, and the proportion of correctly predicted lethal c ourses (sensitivity) is also close to 100%. The significance of the ri sk score lies first in the possibility of giving patients exact data o n the intra- and postoperative risk, and secondly in the provision of an objective measure of quality control - which is legally prescribed in Germany - and comparison with other hospitals. Third, the risk scor e gives clear starting points for research aiming at improvement in th e field of surgery in sick children, and lastly it forms the basis for reliable preoperative recognition of high-risk as needed patients for modern payment methodology of the per-cose costs and thus makes it po ssible to charge accordingly.