Retrospective study of postoperative mortality at a tertiary children's hospital in Iran: A cross sectional study.

INTRODUCTION: Although mortality rates among children after surgery in developing countries are higher than in developed nations, little is known about the causes of post-operative pediatric death. Further insight into post-operative mortality rates and causes of death may help improve postoperative care. The present study investigates in-hospital mortality rates and causes of death at a major pediatric tertiary referral hospital in Iran. METHODS: Patients younger than 18 years of age who underwent surgery with anesthesia between January 1, 2015 and Jan 1, 2018 at Dr. Sheikh Children's Hospital in Mashhad, Iran, were included in this retrospective study. Factors connected to the surgery and mortality rate were analyzed, including patient demographics and comorbidities, surgery type and emergency level, length of operation, and the mortality rate at different time intervals after surgery, were analyzed. RESULTS: A total of 55,027 surgeries were performed between 2015 and 2018, resulting in 214 deaths. Pediatric mortality within 30 days was 78.6 deaths per 10,000 procedures. The highest mortality rate was observed in children under three years of age (67.2 per 10,000), and females were more likely than males to die after an operation (52.8%). The most common comorbidity associated with postoperative death was cardiac disease(18.9%). There was a significant relationship between age and time interval between surgery and death showed (p < 0.0001), and type of surgery (p = 0.013) with the time interval between surgery and death. CONCLUSION: This study demonstrated that patient age and type of surgery were the main predictors of post-operative mortality. STUDY TYPE: Prognosis study. LEVEL OF EVIDENCE: Level II.

Surgery and Anesthesia Management for Intraoral Synechia: A Case Report.

INTRODUCTION: Intraoral synechia is a rare congenital condition, generally associated with other maxillo-facial malformations. We present a neonate with congenital intraoral bilateral synechia without any other facial anomalies. CASE REPORT: In this paper, we present a 19-day-old male neonate with congenital intraoral bilateral synechia without any other facial anomalies. We review the literature to discuss the surgical and anesthesia management of this rare congenital disease. CONCLUSION: The disease manifested with a wide spectrum of symptoms. Most cases need surgery and airway management. In patients with a low risk of bleeding or a compromised airway, it is possible to manage them with face mask-inhalation anesthesia and maintain spontaneous breathing.