Perioperative Risk Factors Associated With Morbidity and Mortality Following Pediatric Inpatient Sinus Surgery

Abstract

Objectives: Pediatric sinus surgery is indicated for a wide range of sinonasal and skull base pathologies, but it is most commonly performed for recalcitrant chronic rhinosinusitis or complicated acute sinusitis. The authors aim to report medical risk factors of morbidity and mortality following inpatient sinus surgery in the pediatric population. Methods: Using data from the Kids' Inpatient Database from 2003 to 2012, patients with International Classification of Diseases, Ninth Revision, procedure codes for primary sinus surgery were identified. Mixed-effect multivariable logistic regression was used to identify risk factors of inpatient postoperative morbidity and mortality. Results: The final sample included a weighted estimate of 4965 pediatric patients. The rates of inpatient morbidity and mortality were 6% and 1%, respectively. Respiratory complications (2.5%) were the most prevalent postoperative adverse events. The most prevalent comorbidities were chronic sinusitis (59.8%), acute sinusitis (27.8%), and cystic fibrosis (26.4%). Compared with patients who did not experience any morbidity, patients with inpatient morbidity had higher rates of pneumonia, mycoses, and nasal or paranasal benign neoplasm (P < .05). The odds of inpatient morbidity and mortality were highest for patients with leukemia (odds ratio, 2.74; 95% confidence interval, 1.59-4.72; P < .001) and mycoses (odds ratio, 15.84; 95% confidence interval, 6.45-38.89; P < .001), respectively. Conclusions: This study is the first to report the national comorbidity burden and risk factors for postoperative adverse events following inpatient sinus surgery. Knowledge of the comorbidities and independent factors associated with morbidity and mortality will help in directing preoperative optimization and counseling.

The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess

“…27 , 33 ESS is not void of surgical risk, particularly for children having urgent or emergent procedures with higher risk for major complication including postoperative bleeding requiring intervention. 34 , 35 Decisions to add ESS should be considered seriously, particularly if the added benefit for management is low. It is also important to keep in mind that in healthy children, acute bacterial sinusitis typically responds readily to antibiotic therapy.…”

Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

“…Administrative databases akin to HUCP KID have demonstrated utility in directing safety and quality improvement due to their ability to identify macro‐level national trends that may not be apparent at a single institution 10 . In addition, previous research has used the HCUP KID database to assess pediatric otolaryngologic conditions and procedures such as epistaxis, functional endoscopic sinus surgery, pituitary surgery, tracheotomy, and subglottic stenosis 9,11–14 . Thus, the purpose of this project was to use data from the largest pediatric inpatient registry to characterize patient demographics, complications, payer status, hospital setting, length of stay, disposition status, and charges of pediatric patients who underwent operative intervention for acute mastoiditis with and without intracranial complications.…”