Advantage of bedside versus conventional operating room surgery in the management of term and preterm newborn infants: a single center retrospective observational study
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In brief
In brief
This retrospective study compared bedside surgery to conventional operating room procedures in 222 neonates, finding that bedside surgery was safe and effective despite being performed on higher-risk preterm infants with lower gestational age and birthweight. Postoperative hypothermia rates were similar between groups, with patient factors rather than surgical location driving adverse outcomes.
- Bedside surgery in NICU is safe for critically ill neonates, with no increased risk of hypothermia or infection versus OR surgery.
- Lower weight at surgery and emergency procedures are independent risk factors for postoperative hypothermia in neonates.
- Lower gestational age and preoperative inotrope requirement predict 30-day mortality, not surgical location.
- Bedside surgery allows intervention in sicker preterm infants who may not tolerate transport to the operating room.
- Mortality differences reflect patient selection (BS group had lower GA, birthweight, worse baseline status), not surgical setting.
Written by the GCMD Library team from the article.
Abstract
Purpose
To compare postoperative outcomes of bedside surgery (BS) with those of surgery performed in the operating room (ORS) in preterm and full-term neonates.
Methods
Data from neonates undergoing major surgical interventions were retrospectively evaluated. Primary outcome was the incidence of postoperative hypothermia. Secondary outcomes were the mortality rate within 30 days of surgery and the occurrence of post-operative infection within 48 h of surgery.
Results
374 interventions performed on 222 neonates were analysed: 55 interventions on 47 neonates in the BS group and 319 interventions on 175 neonates in the ORS group. Compared to the ORS group, infants in the BS group had lower gestational age (GA) and birthweight, higher incidence of morbidity and mortality at discharge. No difference was found in the incidence of postoperative hypothermia and infections within 48 h of surgery, while mortality within 30 days of surgery was higher in the BS group. To multivariable logistic regression analysis, weight at the time of surgery [OR (IC 95%) 0.711 (0.542–0.931); p 0.013] and emergency/urgency modality [OR (IC 95%) 1.934 (1.221–3.063); p 0.005] were identified as variables associated with the risk of hypothermia, while GA [OR (IC 95%) 0.830 (0.749–0.920); p 0.000] and need for pre-surgery inotropes [OR (IC 95%) 8.221 (2.128–31.760); p 0.002] were associated with mortality within 30 days of surgery.
Conclusions
BS resulted safe and effective in not increasing the risk of postoperative adverse events despite being performed in worse clinical conditions than ORS.