The Journal of urology · 2026
Age and Postoperative Unplanned Reintubation: A Retrospective Observational Study Using the NSQIP Pediatric Database.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Michael Jamie, Wu Chunyi, Rosoklija Ilina, Johnson Emilie K, Burjek Nicholas, Lazar Alina, Froyshteter Alexander B, Cheon Eric C, Chu David I
Аннотация
PURPOSE: We evaluated perioperative anesthesia risk in relation to age among children undergoing elective outpatient surgery and assessed 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-Pediatric 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's 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.
MATERIALS AND METHODS: We performed a retrospective cohort study using the National Surgical Quality Improvement Program-Pediatric 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's 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.
Предметные рубрики MeSH
AdolescentChildChild, PreschoolFemaleHumansInfantMaleAge FactorsAmbulatory Surgical ProceduresAnesthesia, GeneralDatabases, FactualElective Surgical ProceduresIntubation, IntratrachealPediatric AnesthesiaPostoperative ComplicationsRespiratory InsufficiencyRetrospective StudiesRisk AssessmentUnited StatesInfant, Newborn