Risk factors for perioperative respiratory adverse events and unplanned intensive care admission in children with juvenile-onset recurrent respiratory papillomatosis undergoing carbon dioxide laser resection.

Abstract

Objective: To identify risk factors for perioperative respiratory adverse events (PRAEs) and unplanned intensive care admission (UIA) in children with juvenile-onset recurrent respiratory papillomatosis (JORRP) undergoing carbon dioxide (CO₂) laser resection.

Methods: This retrospective nested case-control study included 148 JORRP patients who underwent CO₂ laser resection between 2014 and 2023 at Sun Yat-sen Memorial Hospital. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Predictive nomograms were constructed based on the multivariate model. PRAEs were defined as laryngeal edema, bronchospasm, desaturation, emergency reintubation, or tracheostomy occurring within 24 hours post-surgery.

Results: Forty patients (27.0%) required UIA, of whom 36 (24.3% of the total cohort) experienced PRAEs that led to ICU admission. Median age at surgery was 3.8 years. Female sex (OR=4.00, 95% CI 1.07 to 15.87), number of previous surgeries (OR=16.05, 95% CI 3.86 to 66.78), younger age (per year increase, OR=0.70, 95% CI 0.53 to 0.94), longer duration of surgery (OR=1.01, 95% CI 1.01 to 1.02), and tracheal involvement (OR=5.58, 95% CI 1.27 to 24.55) were identified as significant independent risk factors for PRAEs. Similar patterns were observed for UIA. Nomogram analysis demonstrated that young female patients with multiple previous surgeries, prolonged surgical times, and tracheal tumors had the highest risk of respiratory complications.

Conclusions: Patients who are female, younger, have tracheal involvement, multiple previous surgeries, and prolonged operative duration are at significantly higher risk for PRAEs and UIA following CO₂ laser resection for JORRP. These findings provide valuable insights for optimizing perioperative management and improving patient safety in this vulnerable population.