Prolonged Postoperative Mechanical Ventilation (PPMV) in Children Undergoing Abdominal Operations: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database
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In brief
In brief
Large database study identifies key risk factors for prolonged postoperative ventilation in children after abdominal surgery. Neonatal age emerged as the strongest predictor (20-fold increased odds), followed by preoperative inotropic support, prolonged operative time, and high ASA classification.
Written by the GCMD Library team from the article.
Abstract
Background
Prolonged postoperative mechanical ventilation (PPMV) increases length of stay, hospitalization costs, and postoperative complications. Independent risk factors associated with PPMV are not well-known for children.
Method
We identified children (<18 years) in the ACS NSQIP-P database who underwent a general surgical abdominal operation. We excluded children with preoperative ventilator dependence and mortality within 48 h of surgery. PPMV was defined as cumulative postoperative mechanical ventilation exceeding 72 h. A multivariable logistic regression model identified independent predictors of PPMV.
Results
We identified 108,392 children who underwent a general surgical abdominal operation in the ACS NSQIP-P database from 2012 to 2017. We randomly divided the population into a derivation cohort of 75,874(70%) and a validation cohort of 32,518(30%). In the derivation cohort, we identified PPMV in 1,643(2.2%). In the multivariable model, the strongest independent predictor of PPMV was neonatal age (OR:20.66; 95%CI:16.44–25.97). Other independent risk factors for PPMV were preoperative inotropic support (OR:10.56; 95%CI:7.56–14.77), an operative time longer than 150 min (OR:4.30; 95%CI:3.72–4.52), and an American Society of Anesthesiologists classification >3 (OR:12.16; 95%CI:10.75–13.75).
Conclusion
Independent preoperative risk factors for PPMV in children undergoing a general surgical operation were neonatal age, preoperative ionotropic support, duration of operation, and ASA classification >3.