{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:19:51Z","timestamp":1789777191228,"version":"4.0.1"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head & Neck Surgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n Importance:<\/jats:title>\n Preoperative risk factors can guide appropriate postoperative disposition location to a ward bed, intermediate care, or intensive care unit after pediatric microlaryngoscopy and bronchoscopy (MLB), resulting in optimization of resource use and costs.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n Identify risk factors associated with postoperative respiratory events requiring escalation of care after MLB to identify a subpopulation of high-risk patients.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Tertiary pediatric center.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n Patients undergoing MLB alone or with intervention from 2017 to 2023.<\/jats:p>\n <\/jats:sec>\n \n Intervention:<\/jats:title>\n MLB alone or with intervention.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures:<\/jats:title>\n \n Primary outcome was postoperative respiratory events requiring escalation of nursing care: escalation of oxygen supplementation for >2\u2009hours, laryngospasm, bronchospasm, unplanned escalation of care to ICU, O\n 2<\/jats:sub>\n desaturation <80% and Pediatric Early Warning Score (PEW score) >5. Multivariate logistic regression was performed to identify risk factors for postoperative respiratory events.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 420 patients were included. The mean age was 39.4\u2009months and 41% were female. Overall, 229 patients (54.5%) had events that required escalation of care. Five patients (1.2%) had laryngospasm, 5 (1.2%) desaturated below 80%, and 15 (3.6%) required an unplanned escalation of care to the ICU. 157 (37.4%) required escalation of care based on a PEW score >5, and 148 (35.2%) required supplemental O2 for >2\u2009hours. Multivariate analysis identified independent risk factors for postoperative respiratory events including age 1 to 2\u2009years (OR 2.47,\n P<\/jats:italic>\n \u2009=\u2009.037), cardiovascular disease (OR 2.96,\n P<\/jats:italic>\n \u2009=\u2009.0066), GERD (OR 1.89,\n P<\/jats:italic>\n \u2009=\u2009.042), ASA IV (OR 5.76,\n P<\/jats:italic>\n \u2009=\u2009.0032), MLB with supraglottoplasty (OR 4.34,\n P<\/jats:italic>\n \u2009=\u2009.0081), inpatient surgery (OR 4.68,\n P<\/jats:italic>\n \u2009<\u2009.0001), and operative time \u2265180\u2009minutes (OR 2.16,\n P<\/jats:italic>\n \u2009=\u2009.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Risk factors for postoperative respiratory events after MLB include age 1 to 2\u2009years, CVD, GERD, ASA 4, MLB with supraglottoplasty, inpatient emergency, OR time >180\u2009minutes. Tailoring postoperative disposition based on these preoperative risk factors may result in a reduction in ICU utilization while ensuring patients are safely monitored in an appropriate setting.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level 3<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/19160216251398770","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T12:23:46Z","timestamp":1765542226000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors for Postoperative Respiratory Events After Pediatric Microlaryngoscopy and Bronchoscopy"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1040-725X","authenticated-orcid":false,"given":"Jennifer M.","family":"Siu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9850-175X","authenticated-orcid":false,"given":"Justin T.","family":"Levinsky","sequence":"additional","affiliation":[{"name":"Faculty of Science, Western University, London ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Honigman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6408-3639","authenticated-orcid":false,"given":"Siyu","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan J.","family":"Propst","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus E.","family":"Wolter","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.127.5.505"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0165-5876(93)90195-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061942"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.02072001"},{"issue":"11","key":"e_1_3_2_6_2","first-page":"501","article-title":"Factors associated with complications caused by bronchoscopy in pediatric patients","volume":"39","author":"Rodriguez Martinez C","year":"2003","unstructured":"Rodriguez Martinez C, Sossa MP. Factors associated with complications caused by bronchoscopy in pediatric patients. 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