Perioperative Adverse Events in Primary Palatoplasty: "Risk Factors and Impact on Care Escalation in a Multicenter Cohort".

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.