J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251398770. doi: 10.1177/19160216251398770. Epub 2025 Dec 12.
ABSTRACT
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, O 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.
PMID:41384578 | DOI:10.1177/19160216251398770