Surgical Complication Index for Pediatric Patients (SCIPP)

Introduction: Complication rates of children having neurosurgical procedures vary widely. A predictive index for surgical complications in pediatric patients is lacking in the current scientific literature. We have developed an index to accurately predict the likelihood of complications after surgery.

Methods: We conducted a retrospective analysis of 50 pediatric patients who underwent surgeries from August 2021 to July 2023. A Surgical Complication Index for Pediatric Patients (SCIPP) score was established to evaluate the frailty of patients using a ten-point system. Points were awarded for the following criteria: dependence in any activity of daily living (1 point), autonomic dysfunction (1 point), BMI below 1% or above 99% (1 point), incontinence (1 point), previous overnight hospitalization (1 point), impaired mobility (1 point if ambulates with assist, 2 if no ambulation), and polypharmacy (1 point for two daily medications, 2 for more than two). Post-operative complication scores (PCS) were generated by awarding a point for any of the following which occur either post-operatively; fever, non-surgical site infection; or occur anytime within three months after surgery; surgical site infection, new neurological deficit unresolved, return to OR for issue related to surgery, readmission to hospital for issue related to the surgical diagnosis, and mortality. 25 patients with a PCS of 0 and 25 patients with PCS ≥ 1 were collected for correlation with their respective SCIPP scores.

Results: The mean SCIPP score was 1.12 (95% CI 0.38-1.86) for patients with no complications (post-op score of 0) and 2.52 (95% CI 1.67-3.37) for patients with complications (post-op score ≥ 1); (p < 0.01881).

Conclusion : Patients with postoperative complications had higher SCIPP scores than patients with no complications. This indicates the predictive nature of the SCIPP and presents it as a useful tool to counsel patients and families on the risks of surgery. Further development of the tool using a higher volume of patient data, other risk factors such as social challenges, and more granular analysis evaluating whether certain risk factors are more predictive than others is necessary, however.