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Risk factors for peri-operative respiratory adverse events after supraglottoplasty
Melissa Zheng1, Beth Osterbauer2, Christian Hochstim3
1Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA.
Insights
Preoperative ICU admission and intraoperative oxygen desaturations increase the risk of respiratory adverse events (PRAE) after supraglottoplasty. These findings help guide postoperative care decisions for pediatric patients undergoing this procedure.
Area of Science:
- Pediatric Surgery
- Respiratory Medicine
- Critical Care Medicine
Background:
- Supraglottoplasty is a common procedure for laryngomalacia in infants.
- Peri-operative respiratory adverse events (PRAE) requiring intensive care unit (ICU) intervention can occur post-supraglottoplasty.
- Identifying predictive factors for PRAE is crucial for optimizing patient management.
Purpose of the Study:
- To identify demographic and peri-operative characteristics associated with PRAE after supraglottoplasty.
- To inform decisions regarding the appropriate level of postoperative care.
Main Methods:
- Retrospective case series with chart review of children undergoing supraglottoplasty.
- Data collected from October 2014 to November 2019 at a tertiary care children's hospital.
- PRAE defined by specific criteria including failure to extubate, reintubation, or need for advanced respiratory support.
Main Results:
- 41% of 51 subjects experienced PRAE.
- Preoperative ICU admission was strongly associated with PRAE (OR 40.1).
- Intraoperative oxygen desaturations below 90% for over 1 minute were also a significant predictor (OR 21.3).
Conclusions:
- Preoperative ICU admission and intraoperative oxygen desaturations are independent risk factors for PRAE post-supraglottoplasty.
- These findings aid in determining the necessary level of postoperative care.
- Further research may refine risk stratification for pediatric patients undergoing supraglottoplasty.
Objective:
To determine demographic and peri-operative characteristics that predict peri-operative respiratory adverse events (PRAE) requiring intensive care unit (ICU) level intervention after supraglottoplasty.
Study Design:
Case series with chart review.
Setting:
Tertiary care children's hospital.
Methods:
Retrospective chart review was conducted of children with laryngomalacia who underwent supraglottoplasty between October 2014 and November 2019. PRAE were defined as any of the following events or requirements within 24 h of surgery: 1) failure to extubate, 2) reintubation, 3) positive pressure ventilation, 4) more than one dose of racemic epinephrine, or 5) greater than 4 L of oxygen via nasal cannula.
Results:
Fifty-one subjects were enrolled, with a median age of 4.8 months and majority (62 %) Hispanic. Twenty-one (41 %) subjects experienced PRAE. After adjusting for age and gender on multivariate analysis, children admitted preoperatively to the ICU were more likely to have PRAE than those not admitted or admitted to a floor unit (OR 40.1, 95%CI: 4.1-388.6, p = 0.001). Additionally, children with intraoperative oxygen desaturations below 90 % for greater than 1 min were more likely to have PRAE than those who did not (OR 21.3, 95%CI: 2.4-189.9, p = 0.006). Other factors significantly associated with PRAE on univariate analysis included chronic lung disease, congenital cardiac abnormality, history of intubation, supplemental oxygen requirement, gastrostomy tube dependence, intraoperative intubation and longer surgery length.
Conclusion:
Preoperative ICU admission and intraoperative oxygen desaturations are independent risk factors for PRAE after supraglottoplasty. Results from this study can help inform decisions regarding the appropriate level of postoperative care required after supraglottoplasty.
Level Of Evidence:
IV.
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