Perioperative oxygen concentration and postoperative organ damage in pediatric neurosurgery: a retrospective cohort study

Purpose To investigate the correlation between perioperative oxygen concentration and postoperative organ damage and other adverse reactions in children undergoing neurosurgery. Materials and methods This study was a single-center retrospective cohort study that included 512 children undergoing neurosurgery, aged ≤14 years old, and with an operative duration ≥2 hours who were transferred to the Postanesthesia Care Unit (PACU) of the Department of Anesthesiology, Beijing Tiantan Hospital, postop eratively during the period of October 2018 to September 2023. The medical records of the included children during hospitalization were meticulously reviewed and systematically collected through the Hospital Information System (His).The area under oxygen concentration-time curve AUC FIO2 = the product of intraoperative oxygen concentration (percentage) and duration of anesthesia (minutes) was calculated, and then 512 children were divided into 3 groups according to the trichotomies of the AUC FIO2 (Group1:AUC FIO2 <8720%min, Group2: 8720% min ≤ AUC FIO2 ≤ 13800% min, Group 3: AUC FIO2 > 13800% min) for inclusion in the data analysis. Results The incidence of Emergency delirium was 24%, 26.9% and 19.4%, and the incidence of acute kidney injury was 0.6%, 2.3% and 0.6% in the three groups, respectively. There was no significant difference between the three groups (P> 0.05). The incidence of postoperative pulmonary complications in the three groups was 20.6%, 20.8% and 31.5%, respectively, and there was a statistically significant difference between the three comparisons (P<0.05). There were no significant differences in nausea, vomiting, hypoxemia, VAS score and PACU residence time among the three groups during PACU (P>0.05), and there was a statistically significant differences between infections and hospital stay during hospitalization (P<0.05). Conclusions Although the oxygen concentration AUC FIO2 was not correlated with the occurrence of both postoperative AKI and ED, the longer the exposure time of conventional oxygen administration strategy, the higher the incidence of postoperative pulmonary complications and postoperative infections, and the longer the hospitalization time of children.