# Risk Factors for Postoperative Pulmonary Compromise in a Pediatric Population: A Retrospective Review of a Single Institution Cohort

## TL;DR

This study identifies risk factors for postoperative lung issues in young children and shows how these complications lead to longer hospital stays.

## Contribution

The study provides new insights into the timing and risk factors for postoperative pulmonary complications in high-risk pediatric patients.

## Key findings

- 80% of pulmonary complications occurred within 48 hours after surgery.
- ASA class IV and longer surgery time were strong predictors of complications.
- Postoperative pulmonary complications were linked to a 39% longer hospital stay.

## Abstract

Background/Objectives: Pediatric postoperative pulmonary complication is a major event associated with increased in-hospital morbidity and mortality. However, data is limited regarding the specific timing and spectrum of postoperative pulmonary complications in the pediatric population. Utilizing data in a cohort of high-risk patients aged ≤ 6 years, we sought to evaluate the timing and incidence of a composite of postoperative pulmonary complications. We hypothesized that ASA physical status, emergent case type, and procedure duration would be associated with pulmonary complications in high-risk children and that these complications would, in turn, be associated with a prolonged length of stay. Methods: Data from patients ≤ 6 years of age who were intubated for major abdominal surgery at the authors’ institution were collected from 1 January 2019 to 28 March 2022. The primary outcome was postoperative pulmonary complication, defined as the occurrence/use of reintubation, non-invasive positive pressure ventilation, high-flow nasal cannula, mask, or nasal cannula beyond phase 1 of recovery after anesthesia and within 7 postoperative days. The secondary outcome was hospital length of stay. We performed multivariable logistic regression with backward selection to identify independent predictors for postoperative pulmonary complications after adjusting for covariates. For hospital length of stay, a multivariate linear regression model was used after adjusting for covariates. Results: A total of 88 (26.1%) patients experienced 117 occurrences of postoperative oxygen dependence events, and 80 (90.9%) experienced this event in the first 48 h after surgery. The results of this model demonstrated independent associations between patients with an ASA class of IV (OR 9.86, 95% CI: 1.22–79, p-value = 0.03202) and longer operative time (OR: 1.05, 95% CI: 1.03–1.08, p = 0.00001) and postoperative pulmonary complication. On adjusted analysis, the occurrence of a postoperative pulmonary complication was associated with prolonged postoperative length of stay (adjusted geometric mean ratio of 1.39 (95% CI 1.10–1.75, p = 0.0062). Conclusions: Pediatric postoperative pulmonary complication remains a significant event for many patients and results in a prolonged length of stay. This study lays the groundwork for further investigations of interventions targeted at optimizing and monitoring at-risk individuals.