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Perioperative Adverse Events in Primary Palatoplasty: "Risk Factors and Impact on Care Escalation in a Multicenter
Febina Padiyath1,2, Elizabeth M O'Brien1,2, Jennifer Nam3
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Pediatric palatoplasty patients face risks of adverse events, especially hypoxemia and airway obstruction. Prolonged emergence and nasal stents increase these risks, potentially leading to pediatric intensive care unit admission.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Palatoplasty is a common surgical procedure in pediatric patients.
- Perioperative adverse events (PAEs) are a significant concern following palatoplasty.
- Identifying risk factors for PAEs can improve patient outcomes and care planning.
Purpose of the Study:
- To identify the incidence and types of PAEs in pediatric patients undergoing primary palatoplasty.
- To determine risk factors associated with PAEs during the perioperative period.
- To assess the association between PAEs and the need for escalation of care, specifically pediatric intensive care unit (PICU) admission.
Main Methods:
- Retrospective observational study including pediatric patients who underwent primary palatoplasty.
- Data collected from two academic children's hospitals between 2014 and 2020.
- Statistical analysis to identify risk factors for PAEs and their association with PICU admission.
Main Results:
- A total of 459 pediatric patients were included.
- 15% of patients experienced at least one PAE, with hypoxemia and upper airway obstruction being most common.
- Prolonged emergence time and nasal stent placement were significant risk factors for PAEs.
- Any PAE and an increasing number of PAEs were associated with higher odds of unanticipated PICU admission.
Conclusions:
- Pediatric palatoplasty patients are at considerable risk for PAEs, particularly in post-anesthesia recovery.
- Risk factors such as prolonged emergence and nasal stent placement necessitate careful monitoring.
- Early recognition of these risk factors can guide proactive postoperative care and potentially prevent escalation to the PICU.
Background:
Patients undergoing palatoplasty experience perioperative adverse events. Identifying risk factors for perioperative adverse events and escalation of care may improve outcomes.
Methods:
Pediatric patients undergoing primary palatoplasty were included in this retrospective observational study performed at two academic children's hospitals from 2014 to 2020.
Results:
Four hundred fifty-nine patients with a median age of 12 months (IQR: 10-17) and median weight of 9.3 kg (IQR: 8.3-10.9) were included. A perioperative adverse event occurred in 15% (69/459) patients. Multiple (> 1) perioperative adverse events occurred in 18 patients. Hypoxemia (42 events, 9.2%) was the most common perioperative adverse event, followed by upper airway obstruction (29 events, 6.3%), vomiting (11 events, 2.4%), hypoventilation (10 events, 2.2%), and bleeding (7 events, 1.5%). Two events required a rapid response team, and there was 1 cardiac arrest. Forty percent of perioperative adverse events occurred in the post-anesthesia recovery area, and 24% occurred within 12 h of arriving to the floor. Prolonged emergence time (OR 1.04 [95% CI 1.02-1.06], p < 0.001) and nasal stent placement (OR 6.02 [95% CI 2.7-13.6], p < 0.001) were significantly associated with perioperative adverse events and increased odds of unanticipated admission to the pediatric intensive care unit (OR 1.02 [95% CI, 1.01-1.04], p < 0.001) and (OR 3.39 [95% CI, 1.19-8.83], p = 0.016), respectively. The occurrence of any perioperative adverse event (OR 8.47 [95% CI, 4.06-18], p < 0.001) and increasing number of perioperative adverse events (OR 1.75 [95% CI, 1.41-2.24], p < 0.001) were also associated with increased odds of unanticipated PICU admission.
Conclusions:
Patients undergoing palatoplasty are at risk of perioperative adverse events, particularly in post-operative recovery areas, which may result in unanticipated escalation of care. Recognizing the risk factors associated with the development of perioperative adverse events may improve planning of post-operative care and outcomes.
