title: Retrospective audit of unplanned admissions to pediatric high dependency and intensive care after surgery.
abstract: BACKGROUND
  Unplanned admissions to intensive care after surgery are a recommended clinical indicator of patient safety in the perioperative period and are validated to reflect both surgical and anesthesia-related complications.
  
  
  OBJECTIVE
  To determine the rate and reasons for unplanned admissions to high dependency (HDU) and pediatric intensive care (PICU) following noncardiac surgery.
  
  
  METHODS
  Data, including diagnosis, operation, and history of presenting complaint, were retrieved from electronic HDU and PICU data and hospital records for a 5-year period. All cases were individually reviewed by two pediatric anesthetists to identify unplanned admissions along with their urgency, source, and cause.
  
  
  RESULTS
  During the study period, 53,876 procedures were performed resulting in 319 unplanned admissions to HDU/PICU, a rate of 0.6%. Of these, 108 (34%) were related to complications of anesthesia. The rate of unplanned admission to HDU/PICU secondary to a complication of anesthesia was therefore 0.2%. Emergency procedures and procedures involving a shared airway were particular risk factors for admission.
  
  
  CONCLUSIONS
  The rate of unplanned admission to HDU/PICU is low and is comparable to previously published data. The high number of admissions following procedures involving a shared airway may represent patient-related factors and the case mix at this hospital. However, such a finding has prompted a combined ENT and anesthetic review of the care pathway for children with problems following airway instrumentation.
authors.affiliation: School of Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gibson
authors.forename: James
authors.initials: J
authors.lastname: Limb
authors.forename: Graham
authors.initials: G
authors.lastname: Bell
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D002648:Child; D003422:Critical Care / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: anesthesia; clinical audit; intensive care units; pediatric; postoperative complications