Unplanned admission to pediatric intensive care after general anesthesia: A seven-year retrospective cohort study in a tertiary children's hospital

Abstract

Background: Thorough preoperative risk assessment and planning is key to improving patient safety in the perioperative period. Analysis of unplanned ICU admissions after general anesthesia has been validated as a measure of patient safety and its use as a quality initiative is recommended in many countries.

Aims: The aims of this study were to determine the reasons for unplanned ICU admission, required interventions, and outcomes after general anesthesia in our hospital, as well as predictability and preventability of the events that led to admission with a view to improving anesthetic management.

Methods: A single-center, retrospective cohort study in a tertiary children's hospital was performed. All patients under the age of 18 years admitted to our PICU between June 2014 and May 2021 were included. Unplanned ICU admission after general anesthesia was defined as an admission to the ICU either immediately postoperatively or after recovery room stay, which was not planned preoperatively. The reasons for ICU admission were classified as anesthesia-related, surgical, medical, or mixed. Required intervention, length of ICU stay, and patient outcome of each group, as well as preventability and predictability of the events were investigated.

Results: There were 75 admissions, representing 0.23% of all general anesthesia procedures during the study period. "Anesthesia-related" was the major reason for admission of which the majority required observation only or transient respiratory support with a median ICU stay of two days. Most of the admissions for medical reasons required disease-specific interventions resulting in the longest ICU stays with a median of six days. A total of 19% of the admissions were preventable, where most of them were for anesthesia-related reasons, and 33% were predictable. Seven patients required cardiopulmonary resuscitation, of which one patient died, giving an observed mortality rate of 1.3% overall. All but one patient who died demonstrated no changes in the Pediatric Cerebral Performance Category (PCPC) scale.

Conclusion: "Anesthesia-related" was the leading reason for unplanned ICU admissions, of which the majority required only observation or transient respiratory support. All but one patient who died demonstrated no changes in the PCPC scale, presenting favorable outcome overall.

Keywords: PICU; adverse events; general anesthesia.