Retrospective audit of unplanned admissions to pediatric high dependency and intensive care after surgery

Background Unplanned admissions to intensive care after surgery are a recommended clinical indicator of patient safety in the perioperative period and are validated to reflect both surgical and anesthesia-related complications. Objectives To determine the rate and reasons for unplanned admissions to high dependency (HDU) and pediatric intensive care (PICU) following noncardiac surgery. Methods Data, including diagnosis, operation, and history of presenting complaint, were retrieved from electronic HDU and PICU data and hospital records for a 5-year period. All cases were individually reviewed by two pediatric anesthetists to identify unplanned admissions along with their urgency, source, and cause. Results During the study period, 53876 procedures were performed resulting in 319 unplanned admissions to HDU/PICU, a rate of 0.6%. Of these, 108 (34%) were related to complications of anesthesia. The rate of unplanned admission to HDU/PICU secondary to a complication of anesthesia was therefore 0.2%. Emergency procedures and procedures involving a shared airway were particular risk factors for admission. Conclusion The rate of unplanned admission to HDU/PICU is low and is comparable to previously published data. The high number of admissions following procedures involving a shared airway may represent patient-related factors and the case mix at this hospital. However, such a finding has prompted a combined ENT and anesthetic review of the care pathway for children with problems following airway instrumentation.