Postoperative respiratory support requirements after pediatric airway foreign body removal: An exploratory...

Postoperative respiratory outcomes after pediatric airway foreign body removal are often reported as binary complications or intensive care unit admission. These endpoints may obscure clinically relevant differences in respiratory support intensity. This exploratory study evaluated postoperative respiratory support as a graded outcome and examined whether time to surgery alone explained severe postoperative respiratory support requirements.

We performed an exploratory retrospective cohort study at a tertiary pediatric center. Children undergoing airway foreign body removal from January 2020 to December 2025 were screened. Patients admitted to the ICU postoperatively were identified from postoperative destination and ICU admission records. For descriptive comparison, three age-comparable non-ICU reference patients were selected for each ICU patient using a closest-age strategy. Time to surgery was defined as the interval from suspected aspiration or onset of aspiration-related symptoms to bronchoscopy for foreign body removal. The primary outcome was the highest postoperative respiratory support level recorded during postoperative hospitalization, categorized as none, supplemental oxygen, HFNC/NIV, or invasive ventilation.

Among 1083 screened cases, 7 children required postoperative ICU admission and 21 age-comparable non-ICU reference patients were included. ICU patients had a longer median time to surgery than non-ICU reference patients (170 h vs. 24 h), but ranges overlapped substantially (3-1440 h vs. 2-480 h). All non-ICU reference patients required supplemental oxygen only. ICU patients showed graded escalation: supplemental oxygen in 1 patient, HFNC/NIV in 1 patient, and invasive ventilation in 5 patients.

In this exploratory cohort, postoperative respiratory outcome after pediatric airway foreign body removal was better represented as a graded respiratory support spectrum than as a binary complication or ICU endpoint. Temporal delay contributed to risk but did not fully determine postoperative respiratory support requirement.