Lee Hyun Jung, Woo Jae Hee, Cho Sooyoung, Oh Hye-Won, Joo Hyunyoung, Baik Hee Jung
Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
Ther Clin Risk Manag. 2020 Dec 14;16:1227-1234. doi: 10.2147/TCRM.S282494. eCollection 2020.
In pediatric patients, the most common reason for delaying surgical intervention is an upper respiratory tract infection (URI). To date, there has been no consensus regarding the optimal timeframe for deferring surgery in children with URI. We conducted this study to evaluate whether a URI symptom-free period and other risk factors affect the incidence of perioperative respiratory adverse events (RAEs).
The study population included 267 pediatric patients (aged 0 to 13 years) with a recent URI episode who underwent surgery under general anesthesia. Following a retrospective review of medical records, several risk factors including a URI symptom-free period for intra- and postoperative RAEs were analyzed using univariate and multivariate logistic regression analyses.
RAEs occurred in 23 of 267 patients (8.6%). Univariate analysis revealed that abnormal preoperative chest images (odds ratio [OR], 7.48; 95% confidence interval [CI], 2.46-22.68, p < 0.001) and emergency operations (OR, 2.84; 95% CI, 1.03-7.81, p = 0.04) were associated with RAEs. Four variables (abnormal preoperative chest images, emergency operations, age under 1 year and symptom-free period of 7-13 days) with a significance of <0.20 in the univariate logistic regression analysis were selected as candidate risk factors for the multivariate model. Among the four variables, abnormalities in preoperative chest images (OR, 7.60; 95% CI, 2.28-25.3, p = 0.001) and a symptom-free period of 7-13 days (OR, 0.13; 95% CI, 0.02-0.88, p = 0.04) were independently associated with RAEs in multivariate logistic regression analysis.
For pediatric patients who require surgery and have a recent history of URI, procedures should be performed after a URI symptom-free period of at least 1-2 weeks. Confirming the absence of abnormalities in preoperative chest images can reduce the incidence of perioperative RAEs.
在儿科患者中，延迟手术干预的最常见原因是上呼吸道感染（URI）。迄今为止，对于患有URI的儿童推迟手术的最佳时间范围尚无共识。我们进行这项研究以评估URI无症状期和其他风险因素是否会影响围手术期呼吸不良事件（RAE）的发生率。
研究人群包括267例近期有URI发作且接受全身麻醉手术的儿科患者（年龄0至13岁）。在对病历进行回顾性审查后，使用单因素和多因素逻辑回归分析对包括术前和术后RAE的URI无症状期在内的几个风险因素进行了分析。
267例患者中有23例（8.6%）发生了RAE。单因素分析显示，术前胸部影像异常（比值比[OR]，7.48；95%置信区间[CI]，2.46 - 22.68，p < 0.001）和急诊手术（OR，2.84；95% CI，1.03 - 7.81，p = 0.04）与RAE相关。在单因素逻辑回归分析中显著性<0.20的四个变量（术前胸部影像异常、急诊手术、1岁以下年龄和7 - 13天的无症状期）被选为多因素模型的候选风险因素。在这四个变量中，术前胸部影像异常（OR，7.60；95% CI，2.28 - 25.3，p = 0.001）和7 - 13天的无症状期（OR，0.13；95% CI，0.02 - 0.88，p = 0.04）在多因素逻辑回归分析中与RAE独立相关。
对于需要手术且近期有URI病史的儿科患者，手术应在URI无症状期至少1 - 2周后进行。确认术前胸部影像无异常可降低围手术期RAE的发生率。
