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J Pediatr Intensive Care 2022; 11(04): 287-293
DOI: 10.1055/s-0041-1724097
Original Article

Unplanned Postoperative Reintubation in Children with Bronchial Asthma

Peter D. Winch
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Christian Mpody
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Teresa M. Murray-Torres 
3   Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, United States
,
Shannon Rudolph 
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
4   Medical Student Research Program, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Joseph D. Tobias
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Olubukola O. Nafiu
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
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Abstract

Unplanned postoperative reintubation is a serious complication that may increase postsurgical hospital length of stay and mortality. Although asthma is a risk factor for perioperative adverse respiratory events, its association with unplanned postoperative reintubation in children has not been comprehensively examined. Our aim was to determine the association between a preoperative comorbid asthma diagnosis and the incidence of unplanned postoperative reintubation in children. This was a retrospective cohort study comprising of 194,470 children who underwent inpatient surgery at institutions participating in the National Surgical Quality Improvement Program–Pediatric. The primary outcome was the association of preoperative asthma diagnosis with early, unplanned postoperative reintubation (within the first 72 hours following surgery). We also evaluated the association between bronchial asthma and prolonged hospital length of stay (longer than the 75th percentile for the cohort). The incidence of unplanned postoperative reintubation in the study cohort was 0.5% in patients with a history of asthma compared with 0.2% in patients without the diagnosis (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.71–2.89). This association remained significant after controlling for several clinical characteristics (OR: 1.54, 95% CI: 1.17–2.20). Additionally, asthmatic children were more likely to require a hospital length of stay longer than the 75th percentile for the study cohort (adjusted OR: 1.05, 95% CI: 1.01–1.10). Children with preoperative comorbid asthma diagnosis have an increased incidence of early, unplanned postoperative reintubation and prolonged postoperative hospitalization following inpatient surgery. By identifying these patients as having higher perioperative risks, it may be possible to institute strategies to improve their outcomes.

Keywords

asthma - early unplanned reintubation - pediatric


Publication History

Received: 21 October 2020

Accepted: 14 January 2021

Article published online:
03 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis 2014; 18 (11) 1269-1278
    CrossrefPubMedGoogle Scholar
  • 2 Sullivan PW, Ghushchyan V, Navaratnam P. et al. The national cost of asthma among school-aged children in the United States. Ann Allergy Asthma Immunol 2017; 119 (03) 246-252.e1
    CrossrefPubMedGoogle Scholar
  • 3 Kalra M, Buncher R, Amin RS. Asthma as a risk factor for respiratory complications after adenotonsillectomy in children with obstructive breathing during sleep. Ann Allergy Asthma Immunol 2005; 94 (05) 549-552
    CrossrefPubMedGoogle Scholar
  • 4 Kou YF, Sakai M, Shah GB, Mitchell RB, Johnson RF. Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: a cross-sectional study. Laryngoscope 2019; 129 (04) 995-1000
    CrossrefPubMedGoogle Scholar
  • 5 Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2015; 79 (10) 1732-1735
    CrossrefPubMedGoogle Scholar
  • 6 Setabutr D, Patel H, Choby G, Carr MM. Predictive factors for prolonged hospital stay in pediatric tonsillectomy patients. Eur Arch Otorhinolaryngol 2013; 270 (06) 1775-1781
    CrossrefPubMedGoogle Scholar
  • 7 von Ungern-Sternberg BS, Boda K, Chambers NA. et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376 (9743): 773-783
    CrossrefPubMedGoogle Scholar
  • 8 von Ungern-Sternberg BS, Ramgolam A, Hall GL, Sly PD, Habre W. Peri-operative adverse respiratory events in children. Anaesthesia 2015; 70 (04) 440-444
    CrossrefPubMedGoogle Scholar
  • 9 Krishna A, Mpody C, Tobias JD, Nafiu OO. Association of childhood asthma with postoperative pneumonia. Paediatr Anaesth 2020; 30: 1254-1260
    CrossrefPubMedGoogle Scholar
  • 10 Cheon EC, Palac HL, Paik KH. et al. Unplanned, postoperative intubation in pediatric surgical patients: development and validation of a multivariable prediction model. Anesthesiology 2016; 125 (05) 914-928
    CrossrefPubMedGoogle Scholar
  • 11 Eisler LD, Hua M, Li G, Sun LS, Kim M. A multivariable model predictive of unplanned postoperative intubation in infant surgical patients. Anesth Analg 2019; 129 (06) 1645-1652
    CrossrefPubMedGoogle Scholar
  • 12 Ing C, Chui I, Ohkawa S, Kakavouli A, Sun L. Incidence and causes of perioperative endotracheal reintubation in children: a review of 28,208 anesthetics. Paediatr Anaesth 2013; 23 (07) 621-626
    CrossrefPubMedGoogle Scholar
  • 13 Murat I, Constant I, Maud'huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth 2004; 14 (02) 158-166
    CrossrefPubMedGoogle Scholar
  • 14 Mathew JP, Rosenbaum SH, O'Connor T, Barash PG. Emergency tracheal intubation in the postanesthesia care unit: physician error or patient disease?. Anesth Analg 1990; 71 (06) 691-697
    CrossrefPubMedGoogle Scholar
  • 15 Winch PD, Staudt AM, Sebastian R. et al. Learning from experience: improving early tracheal extubation success after congenital cardiac surgery. Pediatr Crit Care Med 2016; 17 (07) 630-637
    CrossrefPubMedGoogle Scholar
  • 16 Miller JW, Vu D, Chai PJ. et al. Patient and procedural characteristics for successful and failed immediate tracheal extubation in the operating room following cardiac surgery in infancy. Paediatr Anaesth 2014; 24 (08) 830-839
    CrossrefPubMedGoogle Scholar
  • 17 Lin HT, Ting PC, Chang WY, Yang MW, Chang CJ, Chou AH. Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: a single-center retrospective case-controlled study in Taiwan from 2005 to 2009. Acta Anaesthesiol Taiwan 2013; 51 (01) 3-9
    CrossrefPubMedGoogle Scholar
  • 18 Ramachandran SK, Nafiu OO, Ghaferi A, Tremper KK, Shanks A, Kheterpal S. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology 2011; 115 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 19 Snyder CW, Patel RD, Roberson EP, Hawn MT. Unplanned intubation after surgery: risk factors, prognosis, and medical emergency team effects. Am Surg 2009; 75 (09) 834-838
    CrossrefPubMedGoogle Scholar
  • 20 Kim M, Rhim SC, Roh SW, Jeon SR. Analysis of the risk factors associated with prolonged intubation or reintubation after anterior cervical spine surgery. J Korean Med Sci 2018; 33 (17) e77
    CrossrefPubMedGoogle Scholar
  • 21 Rosenberg J, Ullstad T, Larsen PN, Moesgaard F, Kehlet H. Continuous assessment of oxygen saturation and subcutaneous oxygen tension after abdominal operations. Acta Chir Scand 1990; 156 (09) 585-590 . Erratum in: Acta Chir Scand 1991 Apr;157(4):301. PMID: 2264436
    PubMedGoogle Scholar
  • 22 Rosenberg J, Ullstad T, Rasmussen J, Hjørne FP, Poulsen NJ, Goldman MD. Time course of postoperative hypoxaemia. Eur J Surg 1994; 160 (03) 137-143
    PubMedGoogle Scholar
  • 23 Bruny JL, Hall BL, Barnhart DC. et al. American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report. J Pediatr Surg 2013; 48 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 24 Saito JM, Chen LE, Hall BL. et al. Risk-adjusted hospital outcomes for children's surgery. Pediatrics 2013; 132 (03) e677-e688
    CrossrefPubMedGoogle Scholar
  • 25 Cameron DB, Rangel SJ. Quality improvement in pediatric surgery. Curr Opin Pediatr 2016; 28 (03) 348-355
    CrossrefPubMedGoogle Scholar
  • 26 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). ACS NSQIP Operations Manual. Accessed September 23, 2020 at: https://www.facs.org/quality-programs/acs-nsqip/joinnow/hospitalreq/scrtrain
    PubMedGoogle Scholar
  • 27 Oofuvong M, Geater AF, Chongsuvivatwong V. et al. Excess costs and length of hospital stay attributable to perioperative respiratory events in children. Anesth Analg 2015; 120 (02) 411-419
    CrossrefPubMedGoogle Scholar
  • 28 Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell Jr DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 2004; 199 (04) 531-537
    CrossrefPubMedGoogle Scholar
  • 29 Brockmann PE, Bertrand P, Castro-Rodriguez JA. Influence of asthma on sleep disordered breathing in children: a systematic review. Sleep Med Rev 2014; 18 (05) 393-397
    CrossrefPubMedGoogle Scholar
  • 30 Perikleous E, Steiropoulos P, Nena E. et al. Association of asthma and allergic rhinitis with sleep-disordered breathing in childhood. Front Pediatr 2018; 6: 250
    CrossrefPubMedGoogle Scholar
  • 31 Sánchez T, Castro-Rodríguez JA, Brockmann PE. Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment. J Asthma Allergy 2016; 9: 83-91
    PubMedGoogle Scholar
  • 32 Hua M, Brady JE, Li G. A scoring system to predict unplanned intubation in patients having undergone major surgical procedures. Anesth Analg 2012; 115 (01) 88-94
    CrossrefPubMedGoogle Scholar