Key result
Systematic review protocol details search strategy for risk factors predicting pediatric airway surgery ICU admissions.
Why the study?
Unplanned perioperative critical care admissions demand significant hospital resources, prompting a synthesis of risk factors predisposing otolaryngology patients undergoing routine upper airway surgery to critical care admission.
What preoperative risk factors increase the odds of unplanned critical care admission in adult and pediatric patients undergoing routine upper airway otolaryngology surgery?
Systematic Review
What preoperative risk factors increase the odds of unplanned critical care admission in adult and pediatric patients undergoing routine upper airway otolaryngology surgery?
Answers are grounded in this paper and cite their sources.
This systematic review and meta-analysis identifies key preoperative risk factors, including cardiac disease in children and congestive heart failure in adults, that significantly increase the odds of unplanned critical care admission following routine upper airway surgery.
Background: Unplanned critical care (CC) admissions in the perioperative period demand significant hospital resources. This study reviews the risk factors predisposing towards CC admission in otolaryngology patients undergoing routine upper airway surgery. Methods: Medline and Embase databases were searched from 1996 to 2021. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies of routine upper airway otolaryngology surgery assessing risk factors for CC were included. Following bias assessment, the ten most frequently studied risks were synthesized to an odds ratio (OR) and 95% confidence interval (CI). Studies were divided into sinonasal and oropharyngeal procedures and adult/pediatric populations. Results: There were 69 included studies totaling 356,180 patients. Reported intensive care utilization was 0.52% (95% CI: 0.49–0.55%) in pediatric patients. Those at risk undergoing oropharyngeal surgery included: age below 3 years (OR =4.14; 95% CI: 3.32–5.18), severe obstructive sleep apnea (OSA) (OR =2.70; 95% CI: 2.14–3.41), obesity (OR =1.82; 95% CI: 1.59–2.07), neuromuscular disorders or cerebral palsy (OR =3.54; 95% CI: 2.74–4.59), chromosomal abnormality (OR =4.32; 95% CI: 3.37–5.54), cardiac disease (OR =3.15; 95% CI: 2.34–4.24) and asthma diagnosis (OR =3.21; 95% CI: 2.20–4.68). Adult intensive care utilization in sinonasal and oropharyngeal surgery were 1.38% (95% CI: 0.89–1.87%) and 0.87% (95% CI: 0.58–1.17%). Those at risk included: severe OSA [mean difference in apnea hypopnea index (AHI) 6.13 (95% CI: 5.11–7.14) events/h] and congestive heart failure (OR =3.47; 95% CI: 2.14–5.60). Obesity [>30 kg/m2 body mass index (BMI)] and concomitant sinonasal and oropharyngeal surgery were not associated with increased odds of CC. Conclusions: Despite limitations due to selection bias and confounding variables, large populations of otolaryngology patients undergoing routine upper airway surgery have been studied with well-defined risk factors for those needing CC use post-surgery. Such data helps to provide a framework to screen at-risk patients and avoid unplanned CC use.
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Lodhia et al. (2025) conducted a systematic review in Routine upper airway surgery in otolaryngology. Patient and surgical risk factors (e.g., smoking, obstructive sleep apnea, diabetes, COPD/asthma, difficult airway, prolonged surgery, cardiovascular disease, obesity, older age, polypharmacy) vs. Absence of risk factors was evaluated on Critical care admission and postoperative morbidity/mortality. Database search strategies across Medline and Embase (1996-present) were defined to identify risk factors for critical care admission following routine upper airway surgery, with no results reported in this appendix.
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