Advantage of bedside versus conventional operating room surgery in the management of term and preterm newborn infants: a single center retrospective observational study

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.