Perioperative Adverse Events in Primary Palatoplasty: “Risk Factors and Impact on Care Escalation in a Multicenter Cohort”

BACKGROUND: Patients undergoing palatoplasty experience perioperative adverse events. Identifying risk factors for perioperative adverse events and escalation of care may improve outcomes. METHODS: Pediatric patients undergoing primary palatoplasty were included in this retrospective observational study performed at two academic children's hospitals from 2014 to 2020. RESULTS: Four hundred fifty-nine patients with a median age of 12 months (IQR: 10-17) and median weight of 9.3 kg (IQR: 8.3-10.9) were included. A perioperative adverse event occurred in 15% (69/459) patients. Multiple (> 1) perioperative adverse events occurred in 18 patients. Hypoxemia (42 events, 9.2%) was the most common perioperative adverse event, followed by upper airway obstruction (29 events, 6.3%), vomiting (11 events, 2.4%), hypoventilation (10 events, 2.2%), and bleeding (7 events, 1.5%). Two events required a rapid response team, and there was 1 cardiac arrest. Forty percent of perioperative adverse events occurred in the post-anesthesia recovery area, and 24% occurred within 12 h of arriving to the floor. Prolonged emergence time (OR 1.04 [95% CI 1.02-1.06], p < 0.001) and nasal stent placement (OR 6.02 [95% CI 2.7-13.6], p < 0.001) were significantly associated with perioperative adverse events and increased odds of unanticipated admission to the pediatric intensive care unit (OR 1.02 [95% CI, 1.01-1.04], p < 0.001) and (OR 3.39 [95% CI, 1.19-8.83], p = 0.016), respectively. The occurrence of any perioperative adverse event (OR 8.47 [95% CI, 4.06-18], p < 0.001) and increasing number of perioperative adverse events (OR 1.75 [95% CI, 1.41-2.24], p < 0.001) were also associated with increased odds of unanticipated PICU admission. CONCLUSIONS: Patients undergoing palatoplasty are at risk of perioperative adverse events, particularly in post-operative recovery areas, which may result in unanticipated escalation of care. Recognizing the risk factors associated with the development of perioperative adverse events may improve planning of post-operative care and outcomes.