title: Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.
abstract: BACKGROUND
  Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature.
  
  
  OBJECTIVE
  To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors.
  
  
  METHODS
  Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics.
  
  
  RESULTS
  Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions.
  
  
  CONCLUSIONS
  This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.
authors.affiliation: 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Landry
authors.affiliation: 2 Department of Anesthesiology, University of California, San Diego, CA, USA.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Gabriel
authors.affiliation: 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sascha
authors.initials: S
authors.lastname: Beutler
authors.affiliation: 3 Chief Quality Officer, US Anesthesia Partners (USAP), Dallas, TX, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.affiliation: 1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: ICU; admission; critical care; intensive care unit; outcomes; pediatrics