Age and Postoperative Unplanned Reintubation: A Retrospective Observational Study Using the NSQIP Pediatric Database

To evaluate perioperative anesthesia risk in relation to age among children undergoing elective outpatient surgery and assess whether 6 months of age represents a potential inflection point in risk.

We performed a retrospective cohort study using the National Surgical Quality Improvement Program-Pediatrics database from 2019 to 2022. Patients aged < 19 years who underwent general anesthesia were included. Exclusions were inpatient status, transfer from an acute care facility, or urgent/emergent cases. We examined age as a continuous variable with restricted cubic splines and as a categorical variable with cutoffs at 6 months, 12 months, 18 months, 3 years, and 6 years. Main study outcomes were respiratory failure requiring unplanned reintubation and a composite outcome of 30-day serious adverse events. Adjusted odds ratios were estimated using multivariable firth penalized logistic regression adjusting for comorbidities including prematurity.

Among 145,965 elective outpatient cases, respiratory failure requiring reintubation occurred in 85 patients (< 0.1%) and 30-day serious adverse events occurred in 126 patients (< 0.1%). When age was modeled as a continuous variable with restricted cubic splines, age demonstrated a significant nonlinear association with the odds of reintubation (P < .001). In multivariable analyses with age as a categorical variable, all age categories ≥ 6 months were associated with significantly decreased odds of respiratory failure requiring reintubation and 30-day serious adverse events compared with < 6 months.

Rates of reintubation and 30-day serious adverse events were low across 145,965 elective, outpatient pediatric surgical cases. Children aged 6 to 11 months had 76% lower odds of reintubation, respiratory failure, cardiac arrest, or death compared with those younger than 6 months. These findings suggest that younger than 6 months undergoing surgery may warrant heightened perioperative vigilance.