Division of Pediatric Neurosurgery.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, and The Ohio State University College of Medicine.
J Neurosurg Anesthesiol. 2024 Jan 1;36(1):37-44. doi: 10.1097/ANA.0000000000000871. Epub 2022 Sep 22.
Most children undergoing craniotomy with general endotracheal anesthesia are extubated postoperatively, but some require unplanned postoperative intubation (UPI). We sought to determine the incidence of UPI and identify associated factors and related postoperative mortality.
The National Surgical Quality Improvement Program for Pediatrics (2012-2018) was used to retrospectively identify patients less than 18 years old who underwent craniotomy for epilepsy, tumor, and congenital/cyst procedures. Perioperative factors associated with UPI were identified with logistic regression models.
We identified 15,292 children, of whom 144 (0.94%) required UPI. Ninety-two (0.60%) children required UPI within the first 3 days after surgery. Postoperative mortality was higher among children with UPI within 3 days than in those with UPI later or not at all (8.0 vs. 2.2 vs. 0.3%, respectively; P <0.001). Posterior fossa procedures trended towards an increased odds of UPI (odds ratio [OR], 1.50; 95% confidence interval [CI] 0.99 to 2.27; P =0.05). Five preoperative factors were independently associated with UPI: age ≤ 12 months (OR, 2.78; 95% CI, 1.29 to 5.98), ASA classification ≥3 (OR, 1.92; 95% CI, 1.12 to 3.29), emergent case status (OR, 2.06; 95% CI, 1.30 to 3.26), neuromuscular disease (OR, 1.87; 95% CI, 1.01 to 3.47), and steroid use within 30 days (OR, 1.79; 95% CI 1.14 to 2.79). Long operative times were independently associated with UPI (200 to 400 vs. <200 min OR, 1.92; 95% CI 1.18 to 3.11 and ≥400 vs. <200 min OR, 4.66; 95% CI 2.70 to 8.03).
Although uncommon, UPI in children who underwent craniotomy was associated with an elevated risk of postoperative mortality. The presence of identifiable risk factors may be used for preoperative counseling and risk profiling in these patients.
大多数接受全身气管内麻醉行开颅术的儿童术后均拔管，但有些儿童需要计划外术后插管（UPI）。我们旨在确定 UPI 的发生率，并确定相关因素和相关术后死亡率。
使用国家小儿外科学质量改进计划（2012-2018 年）回顾性确定年龄小于 18 岁、因癫痫、肿瘤和先天性/囊肿手术而行开颅术的患者。使用逻辑回归模型确定与 UPI 相关的围手术期因素。
我们确定了 15292 名儿童，其中 144 名（0.94%）需要 UPI。92 名（0.60%）儿童在术后 3 天内需要 UPI。UPI 发生在术后 3 天内的儿童的术后死亡率高于 UPI 发生在术后 3 天以后或根本未发生的儿童（8.0%比 2.2%比 0.3%；P<0.001）。后颅窝手术 UPI 的可能性呈上升趋势（比值比[OR]，1.50；95%置信区间[CI]，0.99 至 2.27；P=0.05）。有 5 个术前因素与 UPI 独立相关：年龄≤12 个月（OR，2.78；95%CI，1.29 至 5.98）、ASA 分级≥3（OR，1.92；95%CI，1.12 至 3.29）、紧急病例状态（OR，2.06；95%CI，1.30 至 3.26）、神经肌肉疾病（OR，1.87；95%CI，1.01 至 3.47）和 30 天内使用类固醇（OR，1.79；95%CI，1.14 至 2.79）。较长的手术时间与 UPI 独立相关（200 至 400 分钟与<200 分钟 OR，1.92；95%CI，1.18 至 3.11；≥400 分钟与<200 分钟 OR，4.66；95%CI，2.70 至 8.03）。
尽管罕见，但行开颅术的儿童发生 UPI 与术后死亡率升高相关。存在可识别的危险因素可用于这些患者的术前咨询和风险评估。
