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Updated: Jun 20, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Age and Postoperative Unplanned Reintubation: A Retrospective Observational Study Using the NSQIP Pediatric Database
Jamie Michael1, Chunyi Wu2, Ilina Rosoklija3
1Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, Illinois.
Insights
Children under 6 months old face higher anesthesia risks during elective surgery. Infants aged 6-11 months show significantly reduced odds of adverse events, suggesting increased vigilance for younger children.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes Research
- Health Services Research
Background:
- Perioperative anesthesia risk assessment is crucial for pediatric surgical patients.
- Identifying age-related risk inflection points can optimize patient safety.
- Elective outpatient surgery allows for focused study of specific age groups.
Purpose of the Study:
- To evaluate perioperative anesthesia risk in relation to age in children undergoing elective outpatient surgery.
- To determine if 6 months of age represents a significant inflection point for anesthesia-related risk.
- To inform anesthesia management strategies for pediatric surgical patients.
Main Methods:
- Retrospective cohort study utilizing the National Surgical Quality Improvement Program-Pediatrics database (2019-2022).
- Inclusion of pediatric patients (<19 years) undergoing general anesthesia for elective outpatient procedures.
- Analysis of age as both a continuous and categorical variable, with specific cutoffs including 6 months, to assess outcomes like respiratory failure and 30-day serious adverse events.
Main Results:
- A total of 145,965 elective outpatient cases were analyzed.
- Age demonstrated a significant non-linear association with the odds of reintubation (p<0.001).
- Children aged ≥6 months had significantly decreased odds of respiratory failure and serious adverse events compared to those <6 months.
Conclusions:
- Adverse event rates were low overall in this large cohort.
- Infants aged 6-11 months had 76% lower odds of reintubation, respiratory failure, cardiac arrest, or death compared to infants <6 months.
- Heightened perioperative vigilance is recommended for children under 6 months undergoing surgery.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
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