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Risk Factors for Postoperative Respiratory Events After Pediatric Microlaryngoscopy and Bronchoscopy
Jennifer M Siu1, Samantha Goh1, Justin T Levinsky2
1Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Importance:
Preoperative risk factors can guide appropriate postoperative disposition location to a ward bed, intermediate care, or intensive care unit after pediatric microlaryngoscopy and bronchoscopy (MLB), resulting in optimization of resource use and costs.
Objective:
Identify risk factors associated with postoperative respiratory events requiring escalation of care after MLB to identify a subpopulation of high-risk patients.
Design:
Retrospective cohort study.
Setting:
Tertiary pediatric center.
Participants:
Patients undergoing MLB alone or with intervention from 2017 to 2023.
Intervention:
MLB alone or with intervention.
Main Outcome Measures:
Primary outcome was postoperative respiratory events requiring escalation of nursing care: escalation of oxygen supplementation for >2 hours, laryngospasm, bronchospasm, unplanned escalation of care to ICU, O2 desaturation <80% and Pediatric Early Warning Score (PEW score) >5. Multivariate logistic regression was performed to identify risk factors for postoperative respiratory events.
Results:
420 patients were included. The mean age was 39.4 months and 41% were female. Overall, 229 patients (54.5%) had events that required escalation of care. Five patients (1.2%) had laryngospasm, 5 (1.2%) desaturated below 80%, and 15 (3.6%) required an unplanned escalation of care to the ICU. 157 (37.4%) required escalation of care based on a PEW score >5, and 148 (35.2%) required supplemental O2 for >2 hours. Multivariate analysis identified independent risk factors for postoperative respiratory events including age 1 to 2 years (OR 2.47, P = .037), cardiovascular disease (OR 2.96, P = .0066), GERD (OR 1.89, P = .042), ASA IV (OR 5.76, P = .0032), MLB with supraglottoplasty (OR 4.34, P = .0081), inpatient surgery (OR 4.68, P < .0001), and operative time ≥180 minutes (OR 2.16, P = .05).
Conclusion:
Risk factors for postoperative respiratory events after MLB include age 1 to 2 years, CVD, GERD, ASA 4, MLB with supraglottoplasty, inpatient emergency, OR time >180 minutes. Tailoring postoperative disposition based on these preoperative risk factors may result in a reduction in ICU utilization while ensuring patients are safely monitored in an appropriate setting.
Level Of Evidence:
Level 3.
Insights
Identifying pediatric patients at high risk for respiratory events after microlaryngoscopy and bronchoscopy (MLB) is crucial. Risk factors like age 1-2 years, cardiovascular disease, and inpatient surgery help tailor postoperative care and reduce ICU utilization.
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.
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