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Predictive factors of PACU stay after herniorraphy in infant: a classification and regression tree analysis
Vilnis Silins1, Florence Julien, Christopher Brasher
1Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
Insights
Post-conceptional age, prematurity, general anesthesia, and opioid use predict postoperative recovery time in infants undergoing herniorraphy (surgical hernia repair). These factors help estimate postanesthesia care unit (PACU) stay duration for better surgical planning.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Care
Background:
- Herniorraphy is a frequent pediatric surgical procedure, especially in premature infants.
- Prematurity and sedation are known risk factors for postoperative apnea.
- Predictors for postanesthesia care unit (PACU) stay duration after infant herniorraphy remain underexplored.
Purpose of the Study:
- To identify key factors predicting PACU stay duration in infants undergoing herniorraphy.
- To develop a predictive model for optimizing perioperative care and resource allocation.
Main Methods:
- Retrospective analysis of 296 infants (<6 months) undergoing herniorraphy (Nov 2007-Nov 2009).
- Data collected included: age, gestational age, post-conceptional age, weight, anesthesia type, perioperative medications, surgery duration, PACU stay, and apnea.
- Classification and Regression Trees (CART) with 10-fold cross-validation were employed for data analysis.
Main Results:
- Five significant predictors for PACU stay duration were identified: post-conceptional age <45 weeks, prematurity, general anesthesia, postoperative opioid administration, and intraoperative regional analgesia.
- The CART model effectively predicted PACU stay, explaining 79.7% of variability (76.6% cross-validation).
- A decision tree with eight terminal nodes was constructed.
Conclusions:
- An accurate predictive model for PACU stay in infants undergoing herniorraphy was developed.
- Anesthesia techniques and perinatal factors significantly influence PACU stay duration.
- Findings aid in anticipating and managing recovery times for pediatric patients.
Introduction:
Herniorraphy is a common surgical intervention in infants, particularly in those born prematurely. Prematurity and perioperative sedation have been shown to be risk factors for postoperative apnea. However, their influence upon PACU stay duration has not been evaluated. The goal of this study was to investigate predictive factors for PACU stay in infants undergoing herniorraphy.
Material And Methods:
This study is a retrospective analysis of perioperative data in infants <6 months of age undergoing herniorraphy during the period November 2007-November 2009. Collected data included age, gestational age at birth, post-conceptional age, weight, weight at birth, type of anesthesia (spinal vs general), perioperative administration of opioids and paracetamol, duration of surgery, duration of PACU stay, and apnea in PACU. Data analysis used classification and regression trees (CART) with a 10-fold cross-validation.
Results:
Two hundred and ninety-six patients were included in the analysis. Five parameters were found to predict the duration of PACU stay: a post-conceptional age below 45 weeks, prematurity, general anesthesia, postoperative opioid administration, and the use of intraoperative regional analgesia. CRT method allows constructing a decision tree with eight terminal nodes. The percentage of explained variability of the model and the cross-validation were 79.7% and 76.6%, respectively.
Discussion:
Our study allows construction of an accurate predictive tree for PACU stay during herniorraphy in infants <6 months. Parameters found to influence the duration of PACU stay were related to anesthesia techniques and perinatal outcomes.
