Age and postoperative unplanned reintubation: A retrospective observational study using the NSQIP Pediatric database

PURPOSE: To evaluate perioperative anesthesia risk in relation to age among children undergoing elective outpatient surgery and assess whether 6 months of age represents a potential inflection point in risk. MATERIALS AND METHODS: We performed a retrospective cohort study using the National Surgical Quality Improvement Program-Pediatrics database from 2019-2022. Patients aged <19 years who underwent general anesthesia were included. Exclusions were inpatient status, transfer from an acute care facility, or urgent/emergent cases. We examined age as a continuous variable with restricted cubic splines and as a categorical variable with cutoffs at 6 months, 12 months, 18 months, 3 years, and 6 years. Main study outcomes were respiratory failure requiring unplanned reintubation and a composite outcome of 30-day serious adverse events. Adjusted odds ratios were estimated using multivariable firth penalized logistic regression adjusting for comorbidities including prematurity. RESULTS: Among 145,965 elective outpatient cases, respiratory failure requiring reintubation occurred in 85 patients (<0.1%) and 30-day serious adverse events occurred in 126 patients (<0.1%). When age was modeled as a continuous variable with restricted cubic splines, age demonstrated a significant non-linear association with the odds of reintubation (p<0.001). In multivariable analyses with age as a categorical variable, all age categories ≥6 months were associated with significantly decreased odds of respiratory failure requiring reintubation and 30-day serious adverse events compared to <6 months. CONCLUSION: Rates of reintubation and 30-day serious adverse events were low across 145,965 elective, outpatient pediatric surgical cases. Children aged 6-11 months had 76% lower odds of reintubation, respiratory failure, cardiac arrest, or death compared with those younger than 6 months. These findings suggest that children under 6 months old undergoing surgery may warrant heightened perioperative vigilance.