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

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.

journal_name

Int Forum Allergy Rhinol

journal_title

International forum of allergy & rhinology

authors

Roxbury CR,Li L,Rhee D,Jatana KR,Shah RK,Boss EF

doi

10.1002/alr.21954

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

827-836

issue

eissn

2042-6976

issn

2042-6984

journal_volume

pub_type

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