Safety and Perioperative Adverse Events in Pediatric Endoscopic Sinus Surgery: An ACS-NSQIP-P Analysis

Christopher R. Roxbury, Lilun Li, Daniel Rhee, Kris R. Jatana, Rahul K. Shah, Emily F. Boss

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: This study describes safety outcomes of pediatric endoscopic sinus surgery (ESS) to identify risk factors for 30-day postoperative adverse events using the National Surgical Quality Improvement Program–Pediatric (NSQIP-P) database. Methods: We performed a retrospective cohort study involving patients in the 2012–2015 NSQIP-P database who underwent ESS. Predictors included demographics, comorbidities and surgical acuity. Outcomes included 30-day complications, reoperations, and readmissions. Results: Among 2,061 ESS cases identified, 1,829 (88.7%) were elective and 232 (11.3%) were urgent/emergent. There were 92 (4.5%) readmissions, 54 (2.6%) unplanned reoperations, and 61 (3.0%) complications. On multivariate analysis, readmission was associated with urgent/emergent procedures (OR 2.31, CI 1.36-3.93, p<0.01) and history of bleeding disorder (OR 2.24, CI 1.12-4.44, p = 0.02), reoperation was associated with urgent/emergent procedures (OR 5.78, CI 3.24-10.34, p<0.01), and complications were associated with urgent/emergent procedures (OR 3.81, CI 2.13-6.82, p<0.01) and history of bleeding disorder (OR 5.30, CI 2.74-10.20, p<0.01). Bleeding requiring transfusion was associated with urgent/emergent procedures (OR 9.61, CI 2.90-31.80, p<0.01), history of bleeding disorder (OR 14.16, CI 4.41-45.45, p<0.01), and age <3 years (OR 3.92, CI 0.99-15.61, p = 0.05). Black children were significantly more likely to undergo urgent/emergent surgery than white children (19.7% vs. 9.6%, p<0.01). Conclusions: This multi-institutional study confirms that while pediatric ESS is largely safe, urgent/emergent procedures carry the greatest risk of postoperative adverse events, and black children are significantly more likely to undergo higher acuity surgery than white children. Regardless of procedure acuity, young age and bleeding disorder are associated with higher risk of 30-day adverse events.

Original languageEnglish (US)
Pages (from-to)827-836
Number of pages10
JournalInternational Forum of Allergy and Rhinology
Volume7
Issue number8
DOIs
StatePublished - Aug 2017

Keywords

  • Pediatric rhinology
  • endoscopic sinus surgery
  • post-operative

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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