Neonatal patients are at higher risk in the perioperative period than older infants and children. Extubation as an early goal for NICU patients presenting for surgery is undergoing a renaissance period and an exploration of adverse events following selection for extubation immediately after general anesthesia has not specifically been undertaken in this population.
The objective of this study is to determine the adverse events most commonly encountered in NICU patients recovering from anesthesia in the PACU, quantify the risk of event occurrence, and identify risk factors that may increase the risk of postoperative adverse events.
All NICU patients presenting to the OR 6/1/2014-5/31/2018 who recovered in PACU were included for analysis. Univariate analyses were conducted utilizing the Wilcoxon rank sum test or Fisher exact test. Due to the low event rate, a small-sample generalized estimating equation model was created with a major event composite as the outcome and explanatory variables with p values < 0.1 on univariate analysis. Statistically significant continuous variables were then dichotomized based on Youden index. A p value < 0.05 is statistically significant.
There were 707 operative cases in 607 patients. There were 81 total events recorded and 64/81 were considered to be major events, all of which were respiratory. The risk of any postoperative event was 11.5%, major respiratory event requiring intervention by a nurse or provider was 9.1%, and reintubation was 0.8%. Birth weight < 1.58 kg (OR 3.71; 95% CI 2.11 – 6.53; p < 0.001) and postmenstrual age at surgery < 41 weeks (OR 3.20; 95% CI 1.54 – 6.63; p < 0.001) were strongly associated with an increased risk of a major postoperative respiratory event.
The most important factors associated with major events in the PACU following extubation of NICU patients were birth weight < 1.58 kg and postmenstrual age at surgery < 41 weeks. A patient with both features has a 7-fold increase in the odds of a major respiratory event in the PACU. Careful consideration of the post-operative ventilation and monitoring strategy must be given to patients with low birth weight (< 1.58 kg) or who are < 41 weeks postmenstrual age at the time of surgery.