{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T02:18:05Z","timestamp":1782872285220,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T00:00:00Z","timestamp":1687132800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Unplanned intraoperative extubation is a rare but potentially catastrophic safety event. Inadvertent extubation in the neonatal and pediatric critical care setting is a recognized quality improvement metric whereas literature for intraoperative extubation is scarce. The aim of this study was to identify risk factors and outcomes associated with unplanned intraoperative extubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We queried the National Surgical Quality Improvement Program\u2014Pediatric database from 2019 to 2020 for patients &lt;18\u2009years of age. A total of 253\u2009673 patients were included in the analysis. Associations between demographics, clinical variables, and unplanned intraoperative extubation were evaluated with univariable and multivariable logistic regression models. The primary outcome was unplanned intraoperative extubation. Secondary outcomes were postoperative pulmonary complication, unplanned reintubation within 24\u2009h, cardiac arrest on day of surgery, and surgical site infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Unplanned intraoperative extubation occurred in 163 (0.06%) patients. Specific procedures experienced unplanned intraoperative extubation at a higher rate such as bilateral cleft lip repair (1.31% of procedure type) and thoracic repair of tracheoesophageal fistula (1.11% of procedure type). Age, operative time (z\u2010score), American Society of Anesthesiologists Classification 3 and 4, neurosurgery, plastic surgery, thoracic surgery, otolaryngology, and structural pulmonary\/airway abnormalities were independent risk factors. Unplanned intraoperative extubation was associated with an increased unadjusted risk for postoperative pulmonary complication (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.005; OR, 6.05; 95% confidence interval [CI]: 1.93\u201314.44), unplanned reintubation within 24\u2009h (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.005; OR, 8.41; 95% CI: 2.08\u201334.03), cardiac arrest on day of surgery (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05; OR, 22.67; 95% CI: 0.56\u2013132.35), and surgical site infection (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0005; OR, 3.27; 95% CI 1.74\u20135.67).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Unplanned intraoperative extubation occurs at a higher frequency in a subset of procedures and patient types. Identifying and targeting at\u2010risk patients with preventative measures may decrease the incidence of unplanned intraoperative extubation and its associated outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14709","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T08:01:30Z","timestamp":1687161690000},"page":"746-753","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk factors and outcomes associated with unplanned intraoperative extubation of the pediatric surgical patient: An analysis of the <scp>NSQIP\u2010P<\/scp> database"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1471-359X","authenticated-orcid":false,"given":"Eric C.","family":"Cheon","sequence":"first","affiliation":[{"name":"Department of Pediatric Anesthesiology, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Cheon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Children's Hospital of Orange County  Orange County California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7535-3834","authenticated-orcid":false,"given":"Yeona","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000406"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0268"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2003.03.006"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2012.03920.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.10.149"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0697"},{"key":"e_1_2_9_8_1","unstructured":"User Guide for the 2013 ACS NSQIP Pediatric Participant Use Data File (PUF).Chicago: American College of Surgeons; November 2014 2014."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301082"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200007000-00007"},{"key":"e_1_2_9_11_1","unstructured":"HCUP Clinical Classifications Software (CCS) for ICD\u20109\u2010CM.2015http:\/\/www.hcup\u2010us.ahrq.gov\/toolssoftware\/ccs\/ccs.jsp 2015."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199807000-00016"},{"key":"e_1_2_9_13_1","volume-title":"Hospital Inpatient Statistics, 1996","author":"Elixhauser A","year":"1998"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1047"},{"issue":"2","key":"e_1_2_9_15_1","first-page":"169","article-title":"Tracheal length measurement in intubated neonates to guide the design and use of endotracheal tube glottic depth markings","volume":"9","author":"Cerone JB","year":"2022","journal-title":"Children (Basel)"},{"issue":"6","key":"e_1_2_9_16_1","first-page":"840","article-title":"Dimensions of the growing trachea related to body height. 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