{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:09:35Z","timestamp":1788858575800,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients undergoing palatoplasty experience perioperative adverse events. Identifying risk factors for perioperative adverse events and escalation of care may improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pediatric patients undergoing primary palatoplasty were included in this retrospective observational study performed at two academic children's hospitals from 2014 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four hundred fifty\u2010nine patients with a median age of 12\u2009months (IQR: 10\u201317) and median weight of 9.3\u2009kg (IQR: 8.3\u201310.9) were included. A perioperative adverse event occurred in 15% (69\/459) patients. Multiple (&gt;\u20091) perioperative adverse events occurred in 18 patients. Hypoxemia (42 events, 9.2%) was the most common perioperative adverse event, followed by upper airway obstruction (29 events, 6.3%), vomiting (11 events, 2.4%), hypoventilation (10 events, 2.2%), and bleeding (7 events, 1.5%). Two events required a rapid response team, and there was 1 cardiac arrest. Forty percent of perioperative adverse events occurred in the post\u2010anesthesia recovery area, and 24% occurred within 12\u2009h of arriving to the floor. Prolonged emergence time (OR 1.04 [95% CI 1.02\u20131.06],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and nasal stent placement (OR 6.02 [95% CI 2.7\u201313.6],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were significantly associated with perioperative adverse events and increased odds of unanticipated admission to the pediatric intensive care unit (OR 1.02 [95% CI, 1.01\u20131.04],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and (OR 3.39 [95% CI, 1.19\u20138.83],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016), respectively. The occurrence of any perioperative adverse event (OR 8.47 [95% CI, 4.06\u201318],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and increasing number of perioperative adverse events (OR 1.75 [95% CI, 1.41\u20132.24],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were also associated with increased odds of unanticipated PICU admission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients undergoing palatoplasty are at risk of perioperative adverse events, particularly in post\u2010operative recovery areas, which may result in unanticipated escalation of care. Recognizing the risk factors associated with the development of perioperative adverse events may improve planning of post\u2010operative care and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70224","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T14:05:25Z","timestamp":1779458725000},"page":"1247-1253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Adverse Events in Primary Palatoplasty: \u201cRisk Factors and Impact on Care Escalation in a Multicenter Cohort\u201d"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0933-2957","authenticated-orcid":false,"given":"Febina","family":"Padiyath","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-0980","authenticated-orcid":false,"given":"Elizabeth M.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Ronald Reagan UCLA Medical Center, David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishil","family":"Mehta","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Parris","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Hodges","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goretti","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6459-7983","authenticated-orcid":false,"given":"Vin\u00edcius Caldeira","family":"Quint\u00e3o","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Vieira","family":"Carlos","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5068-1647","authenticated-orcid":false,"given":"Gabriel Soares","family":"de Sousa","sequence":"additional","affiliation":[{"name":"Instituto da Crian\u00e7a e do Adolescente, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Padiyath","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology 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