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Predictors of Intensive Care Unit Stay After Pediatric Supraglottoplasty
William G Albergotti1, Joshua J Sturm1, Amanda S Stapleton1
1Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Most children do not need intensive care unit (ICU) admission after supraglottoplasty. Longer surgery times and nonwhite race predict ICU need, which is usually identified within four hours post-procedure.
Area of Science:
- Pediatric Otolaryngology
- Critical Care Medicine
- Health Services Research
Background:
- Supraglottoplasty is a common pediatric airway procedure.
- Current postoperative management lacks evidence-based guidelines.
- Routine intensive care unit (ICU) admission is standard but may not be universally necessary.
Purpose of the Study:
- To evaluate the necessity of routine ICU admission for all supraglottoplasty patients.
- To identify predictive factors for ICU-level care requirement post-supraglottoplasty.
Main Methods:
- Retrospective case series of 223 pediatric patients (1 month to 18 years) undergoing supraglottoplasty.
- Analysis of immediate postoperative outcomes and criteria for ICU admission.
- Multivariable analysis of 38 potential risk factors for ICU care.
Main Results:
- 11.2% of patients required ICU-level care, with 9 needing intubation.
- Most ICU admissions (20/25) occurred within 4 hours post-surgery.
- Significant predictors for ICU care included longer surgical duration (>30 min), nonwhite race, and preoperative gastroesophageal reflux disease.
Conclusions:
- Routine ICU admission after supraglottoplasty is not warranted for all patients.
- Predictive factors like surgical duration and race can guide ICU admission decisions.
- Early identification of patients needing ICU care is possible within the first four hours.
Importance:
Supraglottoplasty is a common procedure performed without evidence-based postoperative management plans. Patients are routinely admitted to the intensive care unit (ICU) postoperatively, but this may not be necessary in all cases.
Objective:
To determine (1) whether routine admission to the ICU after supraglottoplasty is warranted in all patients who undergo this procedure and (2) which factors predict requirement for ICU-level care.
Design, Setting, And Participants:
Retrospective case series and analysis of immediate postoperative outcomes of all children aged 1 month to 18 years who underwent supraglottoplasty at 1 tertiary-care children's hospital from January 1, 2008, through January 31, 2014. Exclusion criteria included preoperative admission to the ICU, preoperative need for positive-pressure ventilation, history of major airway reconstruction, or any concomitant other major procedure.
Exposure:
Supraglottoplasty.
Main Outcomes And Measures:
Need for ICU-level care as defined by need for intubation, positive-pressure ventilation, multiple doses of racemic epinephrine, or oxygen via nasal cannula at greater than 4 L/min within the first 24 hours.
Results:
Of 223 patients identified, 25 (11.2%) met our criteria for ICU-level care. Nine patients required intubation. Twenty of the 25 patients met ICU criteria within 4 hours of surgery. Univariate analysis was performed on 38 risk factors. Risk factors for ICU requirement that remained statistically significant on multivariable analysis (P < .05) included surgical duration longer than 30 minutes (odds ratio [OR], 4.48 [95% CI, 1.51-13.19]; P = .007), nonwhite race (OR, 4.42 [95% CI, 1.54-12.66]; P = .006), and a preoperative diagnosis of gastroesophageal reflux disease (OR, 0.10 [95% CI, 0.09-0.36]; P < .001).
Conclusions And Relevance:
Our study suggests that most children undergoing supraglottoplasty do not require ICU-level care postoperatively. Those who require ICU-level care are likely to be identified within the first 4 hours after surgery. Consideration for routine ICU admission should be given to those with longer surgical duration and those of nonwhite race.
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