Paediatric difficult intubations and the impact of timing of weekend versus weekday cases: an analysis of the Pediatric Difficult Intubation registry.

BACKGROUND

Off-hours presentation has been shown to be independently associated with tracheal intubation-related adverse events in patients with predicted difficult airway. The comparison of the complication rates of paediatric difficult intubations on weekends vs weekdays is unknown. The primary objective of this retrospective review is to determine the complication rates for paediatric difficult intubation cases that occur on a weekend vs a weekday.

METHODS

We performed a retrospective review of data from the Pediatric Difficult Intubation registry, with service dates June 8, 2012 to May 9, 2023, to compare complication rates (total complications, hypoxaemia, non-hypoxaemia complications, and first-attempt success rate) during paediatric difficult intubations that occurred on the weekends vs weekdays. Research electronic data capture was used to standardise data collection across institutions.

RESULTS

We reviewed a total of 8031 cases of difficult paediatric intubations. Two hundred and eighty-five (3.5%) were performed on the weekend, and 7746 (96.5%) were performed on a weekday. Complication rates with paediatric difficult intubations (total complications, hypoxaemia, and non-hypoxaemia complications) were significantly higher on weekends compared with weekdays. The odds of any complication were more than two times higher on the weekends compared with weekdays (odds ratio 2.13, 95% confidence interval 1.49-3.07, P<0.0001).

CONCLUSIONS

This study supports paediatric anaesthetists' clinical decision-making to postpone nonurgent paediatric procedures in children with a history of a difficult airway from weekend to weekday to decrease risk of airway management complications and improve patient safety and quality of care.