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Safety and Perioperative Adverse Events in Pediatric Endoscopic Sinus Surgery: An ACS‐NSQIP‐P Analysis
Author(s) -
Roxbury Christopher R.,
Li Lilun,
Rhee Daniel,
Jatana Kris R.,
Shah Rahul K,
Boss Emily F.
Publication year - 2017
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21954
Subject(s) - medicine , perioperative , demographics , adverse effect , retrospective cohort study , endoscopic sinus surgery , cohort , multivariate analysis , surgery , pediatrics , demography , sociology
This study describes safety outcomes of pediatric endoscopic sinus surgery (ESS) to identify risk factors for 30‐day postoperative adverse events using the National Surgical Quality Improvement Program–Pediatric (NSQIP‐P) database. Methods We performed a retrospective cohort study involving patients in the 2012–2015 NSQIP‐P database who underwent ESS. Predictors included demographics, comorbidities and surgical acuity. Outcomes included 30‐day complications, reoperations, and readmissions. Results Among 2,061 ESS cases identified, 1,829 (88.7%) were elective and 232 (11.3%) were urgent/emergent. There were 92 (4.5%) readmissions, 54 (2.6%) unplanned reoperations, and 61 (3.0%) complications. On multivariate analysis, readmission was associated with urgent/emergent procedures (OR 2.31, CI 1.36‐3.93, p<0.01) and history of bleeding disorder (OR 2.24, CI 1.12‐4.44, p = 0.02), reoperation was associated with urgent/emergent procedures (OR 5.78, CI 3.24‐10.34, p<0.01), and complications were associated with urgent/emergent procedures (OR 3.81, CI 2.13‐6.82, p<0.01) and history of bleeding disorder (OR 5.30, CI 2.74‐10.20, p<0.01). Bleeding requiring transfusion was associated with urgent/emergent procedures (OR 9.61, CI 2.90‐31.80, p<0.01), history of bleeding disorder (OR 14.16, CI 4.41‐45.45, p<0.01), and age <3 years (OR 3.92, CI 0.99‐15.61, p = 0.05). Black children were significantly more likely to undergo urgent/emergent surgery than white children (19.7% vs. 9.6%, p<0.01). Conclusions This multi‐institutional study confirms that while pediatric ESS is largely safe, urgent/emergent procedures carry the greatest risk of postoperative adverse events, and black children are significantly more likely to undergo higher acuity surgery than white children. Regardless of procedure acuity, young age and bleeding disorder are associated with higher risk of 30‐day adverse events.