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Risk factors associated with unplanned ICU admissions following paediatric surgery: A systematic review
Insights
Unplanned intensive care unit (ICU) admissions in children undergoing surgery are linked to factors like comorbidities and younger age. Identifying these risks can improve postoperative care planning for pediatric surgical patients.
Area of Science:
- Pediatric Surgery
- Intensive Care Medicine
- Patient Safety
Background:
- Unplanned intensive care unit (ICU) admissions are critical indicators of patient safety and hospital care quality.
- Existing research on risk factors for unplanned ICU admissions primarily focuses on adult and non-surgical populations.
- There is a lack of systematic reviews specifically addressing risk factors in pediatric surgical patients.
Purpose of the Study:
- To systematically review and synthesize existing literature on risk factors associated with unplanned ICU admissions in children following surgery.
- To identify key patient, surgical, and anesthetic factors that contribute to unplanned ICU admissions in the pediatric surgical population.
Main Methods:
- A systematic review of published literature was conducted, adhering to PRISMA guidelines.
- Studies were identified using a PECO (Population, Exposure, Comparator, Outcome) strategy focused on pediatric surgical patients and unplanned ICU admissions.
- Study quality was assessed using the Newcastle-Ottawa Scale.
Main Results:
- Seven studies were included, with four rated as high quality.
- The pooled prevalence of unplanned ICU admission was 2.69% (95% CI 0.05–8.6%).
- Significant risk factors identified include comorbidities, younger age, general anesthesia, and specific procedures like abdominal and ENT surgery. Abnormal sleep studies were a risk in adenotonsillectomy.
Conclusions:
- This systematic review identifies significant patient, surgical, and anesthetic risk factors for unplanned ICU admissions in pediatric surgical patients.
- Understanding these factors can guide proactive planning for higher levels of postoperative care.
- Further research is recommended to develop a predictive score for unplanned ICU admissions in this population.
Background:
Unplanned admissions to the intensive care unit (ICU) have important implications in the general management of patients. Research in this area has been conducted in the adult and non-surgical population. To date, there is no systematic review addressing risk factors in the paediatric surgical population.
Objectives:
To synthesise the information from studies that explore the risk factors associated with unplanned ICU admissions following surgery in children through a systematic review process.
Methods:
We conducted a systematic review of published literature (PROSPERO registration CRD42020163766), adhering to the Preferred Reporting of Observational Studies and Meta-Analysis (PRISMA) statement. The Population, Exposure, Comparator, Outcome (PECO) strategy used was based on: population - paediatric population, exposure - risk factors, comparator - other, and outcome - unplanned ICU admission. Data that reported on unplanned ICU admissions following paediatric surgery were extracted and analysed. Quality of the studies was assessed using the Newcastle-Ottawa Scale.
Results:
Seven studies were included in the data synthesis. Four studies were of good quality with the Newcastle-Ottawa Scale score ≥7 points. The pooled prevalence (95% confidence interval) estimate of unplanned ICU stay was 2.69% (0.05 - 8.6%) and ranged between 0.06% and 8.3%. Significant risk factors included abnormal sleep studies and the presence of comorbidities in adenotonsillectomy surgery. In the general surgical population, younger age, comorbidities and general anaesthesia were significant. Abdominal surgery and ear, nose and throat (ENT) surgery resulted in a higher risk of unplanned ICU admission. Owing to the heterogeneity of the data, a meta-analysis with risk prediction could not be performed.
Conclusion:
Significant patient, surgical and anaesthetic risk factors associated with unplanned ICU admission in children following surgery are described in this systematic review. A combination of these factors may direct planning toward anticipation of the need for a higher level of postoperative care. Further work to develop a predictive score for unplanned ICU stay is desirable.
Contributions Of The Study:
Unplanned admissions to the intensive care unit (ICU) have been acknowledged as an overall marker of safety.[1] Awareness of this concept has encouraged research to determine the incidence and risk factors of these occurrences. This research has been interrogated in a systematic review process with beneficial conclusions drawn; however, these studies included adults and non-surgical patients.[2-4] To date, we have not been able to find a systematic review addressing the risk factors associated with unplanned ICU admissions in paediatric surgical patients.
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