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Unplanned, Postoperative Intubation in Pediatric Surgical Patients: Development and Validation of a Multivariable

Eric C Cheon1, Hannah L Palac, Kristine H Paik

  • 1From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Anesthesiology
|September 13, 2016
PubMed

Insights

Unplanned postoperative intubation (UPI) in pediatric patients undergoing noncardiac surgery occurs in 0.2% of cases. Early UPI significantly increases 30-day mortality risk by over 11-fold.

Area of Science:

  • Pediatric Anesthesiology
  • Surgical Quality Improvement
  • Critical Care Medicine

Background:

  • Unplanned postoperative intubation (UPI) in pediatric patients after noncardiac surgery lacks characterization.
  • Predictors and outcomes of UPI require identification to improve patient safety.

Purpose of the Study:

  • To determine the incidence and independent predictors of early UPI in pediatric patients.
  • To evaluate the impact of early UPI on postoperative mortality.

Main Methods:

  • Analysis of 87,920 pediatric patients from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database.
  • Derivation and validation cohorts used to identify predictors via multivariable logistic regression.

Main Results:

  • Early UPI incidence was 0.2% in both cohorts.
  • Independent predictors included operation time, severe cardiac factors, ASA physical status ≥2, CNS tumors, developmental delay, malignancy, and neonate status.
  • Early UPI was associated with an 11.4-fold increased risk of 30-day mortality.

Conclusions:

  • Early UPI in pediatric noncardiac surgery is associated with a substantial increase in 30-day mortality.
  • Identifying high-risk patients enables targeted interventions for outcome prevention.
Abstract

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