Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Heritage College of Osteopathic Medicine - Athens Campus, Athens, OH, USA; College of Medicine, Ohio University, Athens, OH, USA.
Br J Anaesth. 2024 Nov;133(5):1085-1092. doi: 10.1016/j.bja.2024.08.006. Epub 2024 Sep 20.
The risk of respiratory complications is highest in the first 72 h post-surgery. Postoperative respiratory events can exacerbate pre-existing respiratory compromise and lead to reintubation of the trachea, particularly in patients with neurologic disorders. This study examined the association between neurologic comorbidities and unanticipated early postoperative reintubation in children.
This multicentre, 1:1 propensity score-matched study included 420 096 children who underwent inpatient, elective, noncardiac surgery at National Surgical Quality Improvement Program reporting hospitals in 2012-22. The primary outcome was unanticipated early postoperative reintubation within 72 h after surgery. The secondary outcome was prolonged postoperative mechanical ventilation, defined as ventilator use >72 h. We also evaluated 30-day mortality in patients requiring reintubation.
Cerebral palsy was associated with the highest risk of early reintubation (adjusted relative risk [RRadj]: 1.97, 95% confidence interval [CI]: 1.44-2.69; P<0.01), followed by seizure disorders (RRadj: 1.87, 95% CI: 1.50-2.34; P<0.01), neuromuscular disorders (RRadj: 1.76, 95% CI: 1.41-2.19; P<0.01), and structural central nervous system abnormalities (RRadj: 1.35, 95% CI: 1.13-1.61; P<0.01). Unanticipated early postoperative reintubation was associated with an eight-times increased risk of 30-day mortality (adjusted hazard ratio: 8.1, 95% CI: 6.0-11.1; P<0.01). Risk of prolonged postoperative mechanical ventilation was also increased with neurologic comorbidities, particularly seizure disorders (RRadj: 1.73, 95% CI: 1.55-1.93; P<0.01).
Children with neurologic comorbidities have an increased risk of unanticipated early postoperative reintubation and prolonged mechanical ventilation. Given the high mortality risk associated with these outcomes, children with neurologic comorbidities require heightened monitoring and risk assessment.
术后 72 小时内发生呼吸系统并发症的风险最高。术后呼吸系统事件可使原有呼吸系统恶化，并导致气管重新插管，尤其是在患有神经疾病的患者中。本研究检查了神经合并症与儿童意外术后早期再插管之间的关联。
本多中心、1:1 倾向评分匹配研究纳入了 2012 年至 2022 年在国家手术质量改进计划报告医院接受住院、择期、非心脏手术的 420096 名儿童。主要结局是术后 72 小时内意外早期术后再插管。次要结局是术后机械通气延长，定义为呼吸机使用时间>72 小时。我们还评估了需要重新插管的患者 30 天死亡率。
脑瘫与早期再插管的风险最高（调整后的相对风险[RRadj]：1.97，95%置信区间[CI]：1.44-2.69；P<0.01），其次是癫痫（RRadj：1.87，95% CI：1.50-2.34；P<0.01）、神经肌肉疾病（RRadj：1.76，95% CI：1.41-2.19；P<0.01）和结构性中枢神经系统异常（RRadj：1.35，95% CI：1.13-1.61；P<0.01）。意外早期术后再插管与 30 天死亡率增加 8 倍相关（调整后的危险比：8.1，95% CI：6.0-11.1；P<0.01）。神经合并症也会增加术后机械通气延长的风险，尤其是癫痫（RRadj：1.73，95% CI：1.55-1.93；P<0.01）。
患有神经合并症的儿童意外术后早期再插管和延长机械通气的风险增加。鉴于这些结果相关的高死亡率风险，患有神经合并症的儿童需要加强监测和风险评估。
