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Predictors of Perioperative Respiratory Adverse Events in Children Undergoing Surgery for Oropharyngeal Cleft
Usha Shenoy1, Bijoy Chirayath1, P V Narayanan1
1Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India.
Insights
Children with oropharyngeal cleft deformity undergoing surgery face risks of perioperative respiratory adverse events. Higher COLDS scores and Cormack Lehane grade 3 or higher predict these events, with laryngospasm being most common.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Congenital Malformations
Background:
- Oropharyngeal cleft deformity (OPCD) is the most common congenital malformation worldwide.
- Children with OPCD undergoing reconstructive surgery have an increased risk of perioperative respiratory adverse events (PRAEs).
- Predictors for PRAEs in this specific pediatric population remain under-investigated.
Purpose of the Study:
- To identify predictors of PRAEs in children under two years old undergoing elective cleft surgery.
- To determine the incidence of specific PRAEs in this patient group.
Main Methods:
- A single-center, prospective, observational study was conducted.
- 270 children under two years of age undergoing elective cleft surgery were recruited.
- PRAEs, including laryngospasm, bronchospasm, stridor, airway obstruction, and desaturation, were monitored.
Main Results:
- The overall incidence of PRAE was 1.85%, with laryngospasm being the most frequent event.
- A history of upper airway obstruction and feeding disorders, Cormack Lehane (CL) grade ≥3, and COLDS score ≥15 were associated with increased PRAE incidence.
- Multivariate regression confirmed that COLDS score ≥15 (AOR: 18.07) and CL grade ≥3 (AOR: 41.79) were significant predictors of PRAEs.
Conclusions:
- Children with OPCD and higher COLDS scores or CL grade ≥3 are at increased risk for PRAEs post-surgery.
- A history of early infancy airway obstruction or feeding disorders may also increase PRAE risk.
- The low overall incidence of PRAE limits the generalizability of findings.
Background And Objectives:
Children with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.
Materials And Methods:
This single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.
Results:
Of the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade ≥ 3, and COLDS score ≥ 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade ≥ 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score ≥ 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade ≥ 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.
Conclusion:
Children with OPCD with higher COLDS scores and/or those with a CL grade view ≥ 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.
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