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Retrospective audit of unplanned admissions to pediatric high dependency and intensive care after surgery
Alexander R Gibson1, James Limb, Graham Bell
1School of Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Insights
Unplanned admissions to high dependency (HDU) and pediatric intensive care (PICU) after noncardiac surgery occur at a low rate of 0.6%. Anesthesia complications accounted for 0.2% of these admissions, with emergency cases and shared airway procedures being key risk factors.
Area of Science:
- Pediatric Anesthesiology
- Perioperative Patient Safety
- Critical Care Medicine
Background:
- Unplanned admissions to intensive care units (ICUs) post-surgery serve as a critical indicator of patient safety.
- These admissions reflect potential complications arising from both surgical and anesthesia care.
- Monitoring these events is crucial for improving perioperative outcomes.
Purpose of the Study:
- To quantify the incidence of unplanned admissions to high dependency units (HDUs) and pediatric intensive care units (PICUs).
- To identify the primary causes contributing to these unplanned admissions following noncardiac surgical procedures in pediatric patients.
Main Methods:
- A retrospective analysis of electronic HDU and PICU data, alongside hospital records, was conducted over a five-year period.
- Data included patient diagnosis, surgical operation details, and presenting complaint history.
- Two pediatric anesthesiologists independently reviewed all cases to determine the urgency, source, and cause of unplanned admissions.
Main Results:
- A total of 53,876 procedures were analyzed, resulting in 319 unplanned admissions to HDU/PICU, yielding an overall rate of 0.6%.
- Complications related to anesthesia were identified as the cause for 108 (34%) of these admissions, translating to an anesthesia-specific rate of 0.2%.
- Risk factors associated with increased likelihood of unplanned admission included emergency procedures and surgeries involving a shared airway.
Conclusions:
- The overall rate of unplanned admissions to HDU/PICU following noncardiac surgery is low and consistent with existing literature.
- A significant proportion of admissions were linked to procedures involving shared airways, potentially indicating patient-specific factors or the hospital's case mix.
- These findings have initiated a collaborative review by Ear, Nose, and Throat (ENT) and anesthesia departments to optimize care pathways for pediatric patients experiencing airway-related issues post-surgery.
Background:
Unplanned admissions to intensive care after surgery are a recommended clinical indicator of patient safety in the perioperative period and are validated to reflect both surgical and anesthesia-related complications.
Objectives:
To determine the rate and reasons for unplanned admissions to high dependency (HDU) and pediatric intensive care (PICU) following noncardiac surgery.
Methods:
Data, including diagnosis, operation, and history of presenting complaint, were retrieved from electronic HDU and PICU data and hospital records for a 5-year period. All cases were individually reviewed by two pediatric anesthetists to identify unplanned admissions along with their urgency, source, and cause.
Results:
During the study period, 53,876 procedures were performed resulting in 319 unplanned admissions to HDU/PICU, a rate of 0.6%. Of these, 108 (34%) were related to complications of anesthesia. The rate of unplanned admission to HDU/PICU secondary to a complication of anesthesia was therefore 0.2%. Emergency procedures and procedures involving a shared airway were particular risk factors for admission.
Conclusion:
The rate of unplanned admission to HDU/PICU is low and is comparable to previously published data. The high number of admissions following procedures involving a shared airway may represent patient-related factors and the case mix at this hospital. However, such a finding has prompted a combined ENT and anesthetic review of the care pathway for children with problems following airway instrumentation.
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