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Risk Factors for Postoperative Pulmonary Compromise in a Pediatric Population: A Retrospective Review of a Single
Alison Robles1, Mehul V Raval2, Chunyi Wu1
1Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL 60611, USA.
Insights
Pediatric postoperative pulmonary complications are common in high-risk children and linked to longer hospital stays. ASA physical status and longer operative times predict these events, emphasizing the need for targeted interventions.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Pediatric postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality.
- Limited data exists on the timing and spectrum of PPCs in young, high-risk children.
- Understanding PPC predictors is crucial for improving outcomes in pediatric surgery.
Purpose of the Study:
- To evaluate the timing and incidence of PPCs in high-risk children aged ≤ 6 years.
- To identify predictors of PPCs, including ASA physical status, emergent case type, and procedure duration.
- To determine the association between PPCs and hospital length of stay.
Main Methods:
- Retrospective cohort study of pediatric patients (≤ 6 years) undergoing major abdominal surgery.
- Data collected from January 2019 to March 2022.
- Primary outcome: PPC (reintubation, non-invasive ventilation, etc. within 7 days). Secondary outcome: hospital length of stay. Multivariable regression used for analysis.
Main Results:
- 88 patients (26.1%) experienced PPCs, with 90.9% occurring within 48 hours post-surgery.
- Higher ASA physical status (Class IV) and longer operative times were independent predictors of PPCs.
- PPCs were significantly associated with a prolonged postoperative length of stay (adjusted geometric mean ratio 1.39).
Conclusions:
- Pediatric PPCs are a significant concern, leading to extended hospital stays.
- ASA physical status and operative duration are key risk factors for PPCs in this population.
- Further research into targeted interventions for at-risk children is warranted.
Background/Objectives:
Pediatric postoperative pulmonary complication is a major event associated with increased in-hospital morbidity and mortality. However, data is limited regarding the specific timing and spectrum of postoperative pulmonary complications in the pediatric population. Utilizing data in a cohort of high-risk patients aged ≤ 6 years, we sought to evaluate the timing and incidence of a composite of postoperative pulmonary complications. We hypothesized that ASA physical status, emergent case type, and procedure duration would be associated with pulmonary complications in high-risk children and that these complications would, in turn, be associated with a prolonged length of stay.
Methods:
Data from patients ≤ 6 years of age who were intubated for major abdominal surgery at the authors' institution were collected from 1 January 2019 to 28 March 2022. The primary outcome was postoperative pulmonary complication, defined as the occurrence/use of reintubation, non-invasive positive pressure ventilation, high-flow nasal cannula, mask, or nasal cannula beyond phase 1 of recovery after anesthesia and within 7 postoperative days. The secondary outcome was hospital length of stay. We performed multivariable logistic regression with backward selection to identify independent predictors for postoperative pulmonary complications after adjusting for covariates. For hospital length of stay, a multivariate linear regression model was used after adjusting for covariates.
Results:
A total of 88 (26.1%) patients experienced 117 occurrences of postoperative oxygen dependence events, and 80 (90.9%) experienced this event in the first 48 h after surgery. The results of this model demonstrated independent associations between patients with an ASA class of IV (OR 9.86, 95% CI: 1.22-79, p-value = 0.03202) and longer operative time (OR: 1.05, 95% CI: 1.03-1.08, p = 0.00001) and postoperative pulmonary complication. On adjusted analysis, the occurrence of a postoperative pulmonary complication was associated with prolonged postoperative length of stay (adjusted geometric mean ratio of 1.39 (95% CI 1.10-1.75, p = 0.0062).
Conclusions:
Pediatric postoperative pulmonary complication remains a significant event for many patients and results in a prolonged length of stay. This study lays the groundwork for further investigations of interventions targeted at optimizing and monitoring at-risk individuals.
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