Objectives: The aim of this study was to identify the prevalence of unplanned postoperative pediatric intensive care unit (PICU) admissions (UPPAs) and associated patient characteristics. Design: A retrospective, descriptive study at a single institution was conducted from January 1, 2011, to December 31, 2014. Trauma, medical, and weekend admissions were excluded. In addition, cardiac, orthopedic, and urology surgical admissions were excluded. A derived disability level was calculated using the baseline Pediatric Overall and Cognitive Performance Criteria. Mortality risk and acuity scores were compared between UPPAs and planned PICU admissions (PPAs). Outcomes as a function of patient origin (operating room [OR], postanesthesia care unit [PACU], and acute care floor [ACF]) and surgical services were compared. Setting: This study was conducted in a free-standing, tertiary care children's hospital. Patients: Patients admitted to the PICU within 24 hours following an operative procedure. Measurements and Main Results: There were 158 (34%) UPPAs. Compared with postoperative PPAs, UPPAs had higher acuity and mortality scores (p < .05). UPPAs were highest from the OR (58%), followed by those from the PACU (PACU-UPPA, 27%) and ACF (13%). There was no difference in the odds of UPPAs from the OR among surgical services. There was increased odds of PACU-UPPA after otolaryngology (odds ratio = 1.15, p < .0001) and pediatric surgery (odds ratio = 2.19, p < .0001) and the presence of disability (odds ratio = 3.67, p = .011). None of the variables were associated with UPPAs from the ACF. Conclusions: This study identified surgical services and moderate disability as independent risk factors for UPPA. PACU-UPPA may represent an improvement opportunity. It is feasible to derive a risk stratification model for UPPA.

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