Respiratory-Support Phenotypes and In-Hospital Mortality in Pediatric Postprocedural Respiratory Complications.

Background/

Objectives

Postprocedural respiratory complications encompass heterogeneous patterns of invasive respiratory support. We examined whether hospital-course respiratory-support phenotypes were associated with in-hospital mortality among operative pediatric discharges.

Methods

We analyzed the 2022 Healthcare Cost and Utilization Project Kids' Inpatient Database. Discharges with Clinical Classifications Software Refined category RSP017 were restricted to those with a major operating-room procedure. AHRQ Pediatric Quality Indicator 09 timing criteria anchored postoperative mechanical ventilation and intubation. Survey-weighted logistic regression accounted for KID strata, hospital clustering, and discharge weights, and adjusted for age, sex, multisystem complication involvement, AHRQ nonweighted comorbidity burden, and procedure domain.

Results

Of 7378 operative RSP017 discharges, 6358 were aged ≤17 years and 6334 entered the final model, with 216 deaths. Survey-weighted mortality was 35.46% with ECMO support, 7.35% with postoperative 24-96 h ventilation/intubation, 4.71% with postoperative ventilation > 96 h, 4.11% with other invasive support, and 0.73% in the reference phenotype. Corresponding adjusted odds ratios were 60.12, 8.76, 5.28, and 4.85. Before hierarchical assignment, 350/6358 discharges (5.50%) met more than one candidate phenotype definition. Alternative hierarchy and operative-anchor analyses yielded similar associations. When the combined phenotype was disaggregated, qualifying postoperative intubation had a stronger association with mortality than 24-96 h ventilation alone.

Conclusions

Administrative respiratory-support phenotypes were associated with markedly different in-hospital mortality. Findings were robust to alternative classification and timing rules, but the framework is hypothesis-generating and requires external clinical validation.