13 General introduction Chapter 1 This thesis will show that complications following abdominal surgery in young children are not as rare as some might think. This insight is important because of the consequences of postoperative complications. These consequences have a wide- and unpredictable range. They can be tedious, limiting quality of life without being directly life-threatening, such as feeding difficulties, impaired growth and postoperative ileus. Aside from being harmful to patients and parents, these common complications increase hospital stay with conjoined increase in medical costs. However, there are also more grave complications which could necessitate redo-surgery, for example following anastomotic stenosis. These complications too are frequent, as our results will show. The necessity of redo-surgery not only gives rise to repeated risk of postoperative complications, but also repeated surgery at a young age seems to impair neurodevelopment later on in life.[11] The gravest of postoperative complications, mortality, is rare but does occur following postoperative complications. It can occur both relatively quick following surgery (e.g. following anastomotic leakage) as well as later during follow-up (e.g. following bowel ischemia caused by adhesions) the incidence of which warrants further research. Information on incidences of- and risk factors for different postoperative complications could provide context for clinical decision making as well as be of use when informing parents on the expected course of disease. By objectifying which diseases or even more specifically which patients have highest incidence of these complications provides a basis for future research into interventions aiming to minimize these risks in the future of pediatric surgery. From here onwards there will be a brief introduction of common complications following surgery in young children including central catheter associated infections/thrombosis, incisional hernia, obstructive complications, intestinal anastomotic complications and complications following enterostomy formation. 3. Postoperative complications 3.1. Central venous catheter associated infection/thrombosis Total parenteral nutrition via a central venous catheter is essential in case the intestinal tract can’t be used due to severe infections or intestinal blockage (e.g. atresias). Without it, severe malnutrition would be unavoidable. However, central venous catheters themselves can be a cause of severe complications such as central venous catheter associated infections or thrombosis. Since the catheter is directly inserted into a central vein, translocation of bacteria, fungi or viruses via the catheter can cause bloodstream infections causing a systemic inflammatory response. Specifically in neonates, these
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