Prolonged Postoperative Mechanical Ventilation in Children Undergoing Abdominal Operations using the American College of Surgeons National Surgical Quality Improvement Program Database

Background/Purpose: Prolonged postoperative mechanical ventilation (PPMV) can lead to poor outcomes including pneumonia, ventilator-associated lung injury, prolonged hospital length of stay, increased postoperative mortality, and overall increased cost of surgical care. Our objective was to identify independent risk factors for PPMV in pediatric general surgery patients undergoing abdominal operations.

Method: Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified children (<18 years) who underwent inpatient general surgical abdominal operations. We excluded patients with preoperative ventilator dependence and mortality within 48 hours of surgery. We defined PPMV as postoperative mechanical ventilation for longer than 72 hours. We constructed a multivariable logistic regression model to identify independent risk factors for PPMV with a derivation cohort and assessed the model’s discrimination with a validation cohort.

Results: We identified 108484 children who fit the inclusion criteria from 2012 to 2017. The population was randomly divided into a derivation cohort of 75938(70%) and a validation cohort of 32546(30%). In the derivation cohort, we identified PPMV in 1873 (2.5%). In the multivariable model (Figure 1), the strongest independent predictor of PPMV was neonatal age (OR:12.46, 95%CI:9.61-16.16), followed by preoperative inotropic support (OR:5.24, 95%CI:3.54-7.77) and an operative time greater than 150 minutes (OR:5.07, 95%CI:4.34-5.92). Other independent risk factors included age of 1-12 months (OR:4.69, 95%CI:9.61-16.16), ASA class ≥ 3 (OR:3.83, 95%CI:3.36-4.38), preoperative blood transfusion (OR:3.44, 95%CI:2.80-4.24) and history of prematurity (OR:2.49, 95%CI:2.23-2.78). The model demonstrated excellent discrimination in the derivation cohort (C-statistics= 0.91) and the validation cohort (C-statistics= 0.90).

Conclusion: We identified key preoperative risk factors and patient characteristics that are predictive of PPMV in pediatric general surgery patients undergoing abdominal operations. These factors could be used for preoperative risk profiling and counseling caregivers of a patient’s risk for PPMV.