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Age and Postoperative Unplanned Reintubation: A Retrospective Observational Study Using the NSQIP Pediatric Database

Year: 2026

Type: article

Abstract: PURPOSE: We evaluated perioperative anesthesia risk in relation to age among children undergoing elective outpatient surgery and assessed whether 6 months of age represents a potential inflection point in risk. MATERIALS AND METHODS: We performed a retrospective cohort study using the National Surgical Quality Improvement Program-Pediatric database from 2019 to 2022. Patients aged < 19 years who underwent general anesthesia were included. Exclusions were inpatient status, transfer from an acute care facility, or urgent/emergent cases. We examined age as a continuous variable with restricted cubic splines and as a categorical variable with cutoffs at 6 months, 12 months, 18 months, 3 years, and 6 years. Main study outcomes were respiratory failure requiring unplanned reintubation and a composite outcome of 30-day serious adverse events. Adjusted odds ratios were estimated using multivariable Firth's penalized logistic regression adjusting for comorbidities including prematurity. RESULTS: < .001). In multivariable analyses with age as a categorical variable, all age categories ≥ 6 months were associated with significantly decreased odds of respiratory failure requiring reintubation and 30-day serious adverse events compared with < 6 months. CONCLUSIONS: Rates of reintubation and 30-day serious adverse events were low across 145,965 elective, outpatient pediatric surgical cases. Children aged 6 to 11 months had 76% lower odds of reintubation, respiratory failure, cardiac arrest, or death compared with those younger than 6 months. These findings suggest that younger than 6 months undergoing surgery may warrant heightened perioperative vigilance.

Source: The Journal of Urology

DOI: 10.1097/ju.0000000000005177