Incidence and Factors Associated with Perioperative Respiratory Adverse Events in Pediatric Patients with Upper Respiratory Tract Infection Undergoing Surgery Under General Anesthesia: A Retrospective Cohort Study

Objective: The primary objective is to determine the incidence of perioperative respiratory adverse events (PRAEs) in pediatric patients with upper respiratory tract infections (URIs) undergoing general anesthesia (GA); the secondary objective is to identify associated risk factors, including the COLDS score. Materials and Methods: This retrospective cohort study included pediatric patients aged 0–18 years with URIs who underwent surgery under GA at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, between January 1, 2018, and December 31, 2022. Results: A total of 229 pediatric patients were analyzed, with a PRAE incidence of 3.9%. In univariable logistic regression analysis, the American Society of Anesthesiologists (ASA) classification III, severe URI, underlying respiratory disease, endotracheal tube use, emergency surgery, and minor airway surgery (compared with other surgery types) were identified as factors associated with PRAEs. In multivariable analysis, only ASA classification III compared with ASA classification II (adjusted odds ratio [OR] 83.33; 95% CI, 7.10 to 1363.56; p < 0.001) and minor airway surgery compared with other surgery types (adjusted OR 18.54; 95% CI, 1.97 to 237.98; p = 0.009) remained significantly associated with PRAEs. Conclusion: The incidence of PRAEs in pediatric patients with URIs undergoing GA was 3.9%. ASA classification III and minor airway surgery were associated with PRAEs. Careful preoperative assessment and targeted prevention strategies are recommended for pediatric patients with URIs to reduce PRAEs.