title: Risk factors and outcomes of unplanned PICU postoperative admissions: a nested case-control study.
abstract: BACKGROUND
  Although unplanned postoperative admission to PICUs (unplanned intensive care admission [UIA]) is uncommon, it might be associated with increased costs, morbidity, and mortality. However, detailed knowledge of risk factors and outcomes after UIA in children is still lacking.
  
  
  OBJECTIVE
  To determine prevalence, risk factors, and outcomes of UIA patients compared with non-UIA patients.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A tertiary university-affiliated hospital.
  
  
  METHODS
  All postoperative children admitted to the PICU were monitored for UIA. About 28 cases and 88 controls were included.
  
  
  METHODS
  none.
  
  
  RESULTS
  The overall prevalence of UIA was 2.6%. About 28 patients (24.1%) of 116 had unplanned admission. Multiple logistic regression revealed that factors predicting UIA were airway abnormality (odds ratio 16.2, 95% confidence interval 2.65-99.6), anesthetic factors (odds ratio 5.8, 95% confidence interval 1.06-32.2), and hypoxia intraoperative (odds ratio 7.4, 95% confidence interval 1.21-46.24). Procedures on abdomen, emergency surgery, combined anesthesia, and occurrence of intraoperative adverse events were also risk factors for an UIA. Patients with UIA had longer duration of mechanical ventilation than non-UIA patients (4.5 vs. 2 days, p = 0.01), but there were no differences in length of PICU and hospital stays. Preventable adverse events were detected in 25% of UIA children.
  
  
  CONCLUSIONS
  Airway abnormality, anesthetic factors, and hypoxia intraoperative were risk factors associated with UIA. Although preventable events contribute significantly to unplanned PICU admissions, they constitute a room of opportunity in quality improvement programs.
authors: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Estadual de Diadema-UNIFESP, São Paulo, Brazil. psls.nat@terra.com.br
authors: Paulo Sergio Lucas
authors: PS
authors: da Silva
authors: Vânia Euzébio
authors: VE
authors: de Aguiar
authors: Marcelo Cunio Machado
authors: MC
authors: Fonseca
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D015619:Respiratory System Abnormalities / Q000150:complications; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome