Risk Factors for Postoperative Respiratory Events After Pediatric Microlaryngoscopy and Bronchoscopy.

Area of Science:

• Pediatric Otolaryngology
• Pediatric Anesthesiology
• Pediatric Critical Care

Background:

• Preoperative risk stratification optimizes postoperative disposition after pediatric microlaryngoscopy and bronchoscopy (MLB).
• Identifying high-risk patients undergoing MLB can improve resource allocation and patient outcomes.

Purpose of the Study:

• To identify preoperative risk factors for postoperative respiratory events requiring escalation of care after pediatric MLB.
• To define a subpopulation of high-risk patients undergoing MLB.

Main Methods:

• Retrospective cohort study of 420 patients undergoing MLB between 2017-2023.
• Multivariate logistic regression analysis to identify independent risk factors for postoperative respiratory events.
• Primary outcome: respiratory events requiring escalation of care (e.g., oxygen escalation, ICU transfer, PEW score >5).

Main Results:

• Over half (54.5%) of patients experienced events requiring escalation of care.
• Independent risk factors identified: age 1-2 years, cardiovascular disease, GERD, ASA IV, MLB with supraglottoplasty, inpatient surgery, and operative time ≥180 minutes.
• Specific events included oxygen escalation (35.2%) and PEW score >5 (37.4%).

Conclusions:

• Preoperative risk factors such as age, comorbidities (CVD, GERD), ASA status, surgical complexity (supraglottoplasty), and operative factors predict postoperative respiratory events after MLB.
• Tailoring postoperative disposition based on identified risk factors can optimize resource use and ensure appropriate patient monitoring.