Risk Factors for Postoperative Respiratory Events After Pediatric Microlaryngoscopy and Bronchoscopy.

IMPORTANCE

Preoperative risk factors can guide appropriate postoperative disposition location to a ward bed, intermediate care, or intensive care unit after pediatric microlaryngoscopy and bronchoscopy (MLB), resulting in optimization of resource use and costs.

OBJECTIVE

Identify risk factors associated with postoperative respiratory events requiring escalation of care after MLB to identify a subpopulation of high-risk patients.

DESIGN

Retrospective cohort study.

SETTING

Tertiary pediatric center.

PARTICIPANTS

Patients undergoing MLB alone or with intervention from 2017 to 2023.

INTERVENTION: MLB alone or with intervention.

MAIN OUTCOME MEASURES: Primary outcome was postoperative respiratory events requiring escalation of nursing care: escalation of oxygen supplementation for >2 hours, laryngospasm, bronchospasm, unplanned escalation of care to ICU, O2 desaturation <80% and Pediatric Early Warning Score (PEW score) >5. Multivariate logistic regression was performed to identify risk factors for postoperative respiratory events.

RESULTS

420 patients were included. The mean age was 39.4 months and 41% were female. Overall, 229 patients (54.5%) had events that required escalation of care. Five patients (1.2%) had laryngospasm, 5 (1.2%) desaturated below 80%, and 15 (3.6%) required an unplanned escalation of care to the ICU. 157 (37.4%) required escalation of care based on a PEW score >5, and 148 (35.2%) required supplemental O2 for >2 hours. Multivariate analysis identified independent risk factors for postoperative respiratory events including age 1 to 2 years (OR 2.47, P = .037), cardiovascular disease (OR 2.96, P = .0066), GERD (OR 1.89, P = .042), ASA IV (OR 5.76, P = .0032), MLB with supraglottoplasty (OR 4.34, P = .0081), inpatient surgery (OR 4.68, P < .0001), and operative time ≥180 minutes (OR 2.16, P = .05).

CONCLUSION

Risk factors for postoperative respiratory events after MLB include age 1 to 2 years, CVD, GERD, ASA 4, MLB with supraglottoplasty, inpatient emergency, OR time >180 minutes. Tailoring postoperative disposition based on these preoperative risk factors may result in a reduction in ICU utilization while ensuring patients are safely monitored in an appropriate setting.

LEVEL OF EVIDENCE: Level 3.