Bedside Surgery in Critically Ill Neonates: Moving Beyond the Mortality Paradox

In brief

This article examines a meta-analysis comparing bedside versus operating room surgery in critically ill neonates, which found higher mortality in bedside cases. The piece critically evaluates the mortality paradox, likely driven by selection bias where the sickest infants undergo bedside procedures due to instability for transport.

• Bedside surgery in critically ill neonates shows 6.8× higher mortality vs OR, but this likely reflects selection bias not causation.
• Sicker neonates unable to tolerate transport are selected for bedside surgery, confounding mortality comparisons.
• Current evidence cannot determine if bedside surgery is inferior or if it enables intervention in otherwise inoperable patients.
• Prospective studies with severity-adjusted outcomes are needed to evaluate true safety of bedside neonatal surgery.
• Clinical decision should weigh individual patient stability and transport risk rather than rely on aggregate mortality data.

Written by the GCMD Library team from the article.