Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric ® Analysis

Area of Science:

• Pediatric Anesthesiology
• Neurosurgery
• Healthcare Quality Improvement

Background:

• Most children undergoing craniotomy are extubated postoperatively.
• A subset of these patients require unplanned postoperative intubation (UPI).
• UPI is associated with increased risks and resource utilization.

Purpose of the Study:

• To determine the incidence of UPI in pediatric craniotomy patients.
• To identify perioperative factors associated with UPI.
• To assess the relationship between UPI and postoperative mortality.

Main Methods:

• Retrospective analysis of the National Surgical Quality Improvement Program for Pediatrics (2012-2018).
• Inclusion of patients under 18 undergoing craniotomy for epilepsy, tumor, or congenital/cyst procedures.
• Logistic regression models used to identify factors associated with UPI.

Main Results:

• 15,292 children were analyzed; 144 (0.94%) required UPI.
• UPI within 3 days was associated with higher mortality (8.0%) compared to later UPI or no UPI (2.2% vs. 0.3%).
• Independent risk factors for UPI included young age (≤12 months), high ASA classification (≥3), emergent surgery, neuromuscular disease, steroid use, and longer operative times.

Conclusions:

• UPI is an uncommon but significant complication following pediatric craniotomy.
• UPI is associated with an elevated risk of postoperative mortality.
• Preoperative identification of risk factors can aid in counseling and risk stratification.