Risk Factors for Postoperative Complications Following Emergency Abdominal Surgery: A Prospective Pediatric Cohort.

Abstract

Background: Postoperative complications remain a significant concern in pediatric emergency abdominal surgery. However, reliable predictors to anticipate these adverse events are lacking in the pediatric population. The aim of this study was to identify risk factors for postoperative complications in children undergoing emergency abdominal surgery.

Methods: Following the approval by our institutional ethics committee, we conducted a prospective study from January 1, 2022, to December 31, 2024, in a pediatric surgery department. All children under 14 years of age who underwent emergency abdominal surgery were included.

Results: A total of 582 patients were included. The median age was 9 years, and 66.7% were male. Acute appendicitis was the most common surgical condition (n = 515), followed by intussusception (n = 15), ovarian torsion (n = 14), and complicated Meckel's diverticulum (n = 10). Postoperative complications occurred in 12.4% of cases. These complications included surgical site infection (n = 35), adhesive small bowel obstruction (n = 13), postoperative sepsis (n = 8), intra-abdominal abscess (n = 7), respiratory infections (n = 4), urinary tract infections (n = 3), and prolonged postoperative bleeding (n = 2). On multivariate analysis, four independent predictive factors of postoperative complications were identified: symptom duration > 48 h, pediatric comorbidity index ≥ 3, white blood cell count > 15 × 10⁹/l, and operative time > 100 min.

Conclusion: Systematic assessment of these risk factors may contribute to early risk stratification, guide postoperative monitoring decisions, and justify the use of more aggressive or prolonged antibiotic therapy in selected high-risk patients.