Incidence and Predictors of Post-operative Hypoxemia in Pediatric Patients Undergoing General Anesthesia: a Single-arm Prospective Multi-center Cohort Study 2023

Abstract Background: Pediatrics use more oxygen than adults do, which has an impact on how quickly the body desaturates after an apnea. Depending on age and other physiological parameters, the clinically relevant hypoxemia in pediatric patients can drop to 40% in as little as 1.5 minutes, which makes the transfer to the Post-Anesthesia Care Unit (PACU) a risky phase. Postoperative hypoxemia (POH) happens critically postoperatively and various factors predict POH. The objective of the study is to determine the incidence and predictors of POH in pediatric patients undergoing general anesthesia (GA) at Hawassa University Comprehensive Specialized Hospital (HUCSH), Saint Peter Specialized Hospital, and Tikur Anbessa Specialized Hospital (TASH) Methodology: In 292 pediatric patients, a single-arm prospective multi-center cohort study using systematic random sampling was carried out. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 25.00 software. For logistic regression, a Hosmer-Lemeshow goodness of fit test was used (variables with a p > 0.05 were considered fit). Binomial logistic regression and multivariable analysis were performed. Independent variables were examined for multicollinearity, and those exhibiting a variance inflation factor (VIF) > 10 were removed. Additionally, the association between the variables was determined using Pearson chi-square, and p < 0.05 indicated statistically significant variables. Results : The incidence of POH was 47.9%. Pediatric age (≤ 2 years), opioids, and above-abdominal surgeries are associated with POH (p = < 0.001) and AOR = 3.263 (1.686–6.314), 5.545 (2.983–10.307), and 3.642 (1.969–6.736), respectively. Additionally, the presence of at least one comorbidity, use of muscle relaxants, prolonged anesthesia, and surgery duration are associated with POH (p = 0.001, 0.003, 0.02, and 0.037) and AOR = 4.259 (1.788–10.145), 29.72 (3.262–270.778), 2.153 (1.131–4.1), and 2.560 (1.058–6.196), respectively. However, anesthesia type is insignificantly associated with POH (p = 0.096). Conclusion: The incidence of POH in pediatric patients undergoing GA is high, and the presence of at least one comorbidity, pediatric age (≤ 2 years), use of opioids and muscle relaxants, above-abdominal surgeries, prolonged anesthesia, and surgery durations are significantly associated with POH. We recommend taking precautions, following them and having oxygen therapy for these high-risk pediatric patients.