Evaluation of post-operative pediatric surgery patients followed in pediatric intensive care

Objective: Patients who were operated by a pediatric surgeon and followed up post-operatively in the pediatric intensive care unit were included in this study. The effects of the parameters monitored in the post-operative period on the duration of intensive care unit and hospital stay and mortality were evaluated. The questions how post-operative follow-ups should be done and which patients should be followed in intensive care were sought. Material and Method: 143 patients who were operated between September 2018 and January 2020 and hospitalized in the pediatric intensive care for post-operative follow-up were included in the study. The files of the patients were scanned retrospectively. Results: The main problem requiring surgery in patients is respiratory (48.3%), and the second surgery was often performed for gastrointestinal reasons (25.2%). The most common surgical procedure performed to the patients was bronchoscopy (42%). The length of pediatric intensive care stay was not statistically different in patients with at least one comorbid condition and patients without comorbidity (p=0.056). However, a significant difference was found between the two groups in terms of length of hospital stay (p=0.006). No statistically significant difference was found between the rate of attachment to the mechanical ventilator between those with and without comorbidity (p=0.797) Patients who received intra-operative blood products were found to stay in the intensive care unit and stay in the hospital; significantly longer than those who did not (p<0.001). In addition, the average PRISM-3 score at the time of admission was higher than those who did not (p=0.005). 7.7% of the patients needed a mechanical ventilator. The hospital stay of these patients was significantly longer than those who were not attached (p=0.04). However, the difference between the length of pediatric intensive care stay was not statistically significant (p=0.06). No statistically significant difference was found between the highest lactate values on the first day of those who were connected to an invasive mechanical ventilator and those who were not (p=0.660). There were 3 patients who needed inotropes (2.1%). Intensive care stay of these patients was significantly longer than other patients (p = 0.004). There was no statistically significant difference in the length of hospital stay (p = 0.062). Intra-abdominal hypertension developed in 4.9% of the patients. Both the length of pediatric intensive care stay (p<0.001) and the length of hospital stay (p=0.040) were statistically longer in these patients compared to other patients. Sepsis developed in 4.9% of the patients. In patients with sepsis, both the length of pediatric intensive care stay (p<0.001) and the length of hospital stay (p<0.001) were found to be statistically significantly longer than those without sepsis. In patients with sepsis, the rate of intra-abdominal hypertension was statistically significantly higher than in patients who did not (p=0.003). All 3 patients who were given inotropes in the post-operative period; blood product transfusion was performed in the intra-operative period. Seven of the patients (%4.9) in our study had an unplanned operation, and 136 (%95.1) had a planned operation. Both the mean length of pediatric intensive care stay (p=0.000) and the length of hospitalization (p=0.007) of the patients who underwent unplanned operation were found to be statistically significantly longer than those who underwent planned procedures. It was found that the presence of sepsis prolonged the pediatric intensive care stay by an average of 4.46 days, the need for inotropes by 3.61 days, the development of intra-abdominal hypertension by 3.33 days, and the presence of comorbidity by 0.86 days. It was found that the presence of sepsis prolonged the hospitalization period by 28.04 days on average, the need for respiratory support by 21.78 days, and the presence of growth retardation by 14.42 days. The risk of developing hypothermia was found to be significantly higher in those with malnutrition (p = 0.001). Only 1 patient died during follow-up. This patient was also the only patient who underwent a second operation and the only patient who received renal replacement therapy. Conclusion: The most important factors that prolong the stay in the pediatric intensive care unit are the development of sepsis, the need for inotropes, the development of intra-abdominal hypertension and the presence of comorbidity. The most important factors that prolong the hospital stay are the development of sepsis, the need for respiratory support and the presence of growth and development retardation. Therefore, it is very important to pay attention to asepsis rules in the peroperative period, to detect and prevent shock early, and to perform intra-abdominal pressure monitoring in necessary patients. In order to minimize the risk of post-operative complications, non-invasive and invasive monitoring should be followed closely, and patients with high risk of complications should be followed up in the pediatric intensive care unit. Keywords: Post-operative follow-up, length of stay, complication, pediatric intensive care unit