O2144: Mortality from Unintentional Errors in Surgical and Endoscopic Procedures in Pediatric Patients: A Nationwide Analysis from 1999 to 2020

Background: Despite extensive surgical quality improvement initiatives aimed at improving perioperative patient safety, unintentional errors during pediatric surgical procedures continue to contribute to patient morbidity and mortality. Nationwide statistics on childhood mortality resulting from surgical errors in the United States remain unexplored. This study aimed to contextualize and describe these trends over the past 2 decades.

Methods: We used the Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research (CDC WONDER) database, to extract and analyze death certificates from January 1999 to December 2020 for mortality due to errors during surgical and endoscopic procedures. Records were extracted for patients ≤18 years old, using International Statistical Classification of Diseases Tenth Revision (ICD-10) codes Y60.0, Y60.4, Y61.0, Y61.4, Y62.0, Y62.4, Y65.2, Y65.4, Y65.5, and Y83. Data was abstracted for demographics, urban-rural classification, and geographic details. Crude death rates (CDRs) per 1,000,000 persons were calculated, and Joinpoint Regression Program (Joinpoint V 4.9.0.0 National Cancer Institute) was used to determine the annual percentage changes (APC) in CDRs.

Results: Between 1999 and 2020, a total of 9937 deaths occurred from errors in surgical and endoscopic procedures in pediatric patients in the United States. CDR decreased from 6.8 in 1999 to 2.9 in 2014, followed by a period of upward trend towards 4.4 in 2020 (Graph 1 in Figure 1). There was no significant difference in mortality between the two genders, however, geographical differences were noticeable, with Minnesota and Louisiana having CDRs above the 90th percentile (Map 1 in Figure 2). A similar trend was observed for the East South Central census division (Map 2 in Figure 2). However, this data only includes states with reliable data that were included. For large urban regions, CDR was declining at APC of -5.41 from 1999 to 2015, followed by a steep upward trend with APC of 14.41 from 2015 to 2020 (Graph 2 in Figure 1). A similar trend was noted for medium urban regions. In contrast, rural regions saw a declining trend with APC -5.3 from 1999 to 2011, followed by a steady CDR ranging within 6.6 to 9 with APC of 0.29 from 2011 to 2020. Infants, particularly those aged ≥28 days, were the age group most affected, with CDR consistently higher than all other age groups (Graph 3 in Figure 1).

Conclusion: Following a period of consistent decline, mortality in children from unintentional errors in pediatric surgical and endoscopic procedures have increased since 2014. By 2020, mortality rates were highest among infants aged ≥28 days, especially in metropolitan areas. Efforts should focus on examining the causes behind these increasing error rates, particularly in the most affected regions, to implement targeted interventions.