Predictors of Perioperative Respiratory Adverse Events in Children Undergoing Surgery for Oropharyngeal Cleft Deformity: A Prospective Observational Study (PRAE-OPCD Study)

Background and ObjectivesChildren with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.Materials and MethodsThis single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.ResultsOf the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade >= 3, and COLDS score >= 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade >= 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score >= 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade >= 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.ConclusionChildren with OPCD with higher COLDS scores and/or those with a CL grade view >= 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.