Table 4.
Odds Ratio and 95% CI for the Risk Factors Associated with Any Adverse Events during Airway Management
| Patient and Airway Management Characteristics | Univariate Analysis (n = 17,007) | Multivariable Analysis (n = 16,990) | ||||
|---|---|---|---|---|---|---|
| Yes | No | OR (95% CI); P Value | OR (95% CI); P Value | |||
| Total | SD, IQR, or No. (%) | Total | SD, IQR, or No. (%) | |||
| Mean age, yr | 4.7 | 4.4 | 6.3 | 4.8 | 0.92 (0.90–0.94); P < 0.001 | 0.92 (0.90–0.95); P < 0.001 |
| Sex (male vs. female) | 9,959 | 227 (2.3) | 7,045 | 119 (1.7) | 1.39 (1.10–1.76); P = 0.007 | 1.42 (1.12–1.80); P = 0.004 |
| Median body weight, kg* | 13.9 | 8.5, 21.2 | 17.5 | 10.7, 29.5 | ||
| Place for airway management | ||||||
| Mixed adult–pediatric hospital vs. pediatric hospital |
2,584 | 58 (2.2) | 14,423 | 288 (2.0) | ||
| Catheter laboratory vs. operating room† | 262 | 4 (1.5) | 16,624 | 337 (2.0) | 1.00 (0.349–2.89); P = 0.99 | 1.01 (0.337–3.02); P = 0.99 |
| CT, MRI, radiation therapy rooms vs. operating room‡ | 49 | 4 (8.2) | 16,624 | 337 (2.0) | 5.3 (1.59–17.3); P = 0.006 | 5.7 (1.64–19.9); P = 0.006 |
| Respiratory comorbidity | ||||||
| Respiratory support | 771 | 25 (3.2) | 16,236 | 321 (2.0) | ||
| Hypoxemia§ | 507 | 12 (2.4) | 16,500 | 334 (2.0) | ||
| Apneic events | 101 | 2 (2.0) | 16,906 | 344 (2.0) | ||
| Upper airway obstruction | 381 | 13 (3.4) | 16,626 | 333 (2.0) | ||
| Laryngeal abnormalities | 376 | 6 (1.6) | 16,631 | 340 (2.0) | ||
| Respiratory comorbidity | 1,561 | 41 (2.6) | 15,446 | 305 (2.0) | 1.36 (0.96–1.94); P = 0.086 | 0.78 (0.51–1.20); P = 0.258 |
| Airway sensitivity | ||||||
| Active URI symptoms | 422 | 20 (4.7) | 16,585 | 326 (2.0) | ||
| URI within 14 days without active symptoms | 486 | 18 (3.7) | 16,521 | 328 (2.0) | ||
| Asthma | 195 | 7 (3.6) | 16,812 | 339 (2.0) | ||
| Living with an active smoker | 2,048 | 38 (1.9) | 14,959 | 308 (2.1) | ||
| Airway sensitivity | 2,983 | 79 (2.7) | 14,024 | 267 (1.9) | 1.47 (1.11–1.96); P = 0.008 | 1.46 (1.09–1.94); P = 0.010 |
| Environmental sensitivity | ||||||
| Allergy for food or medication | 807 | 17 (2.1) | 16,200 | 329 (2.0) | ||
| Allergic rhinitis | 463 | 9 (1.9) | 16,544 | 337 (2.0) | ||
| Atopic dermatitis | 407 | 6 (1.5) | 16,600 | 340 (2.1) | ||
| Environmental sensitivity | 1,532 | 30 (2.0) | 15,475 | 316 (2.0) | 0.97 (0.65–1.45); P = 0.883 | 1.09 (0.73–1.65); P = 0.667 |
| Cardiovascular comorbidity | ||||||
| Shock status or cardiac arrest | 51 | 2 (3.9) | 16,956 | 344 (2.0) | ||
| Congenital cardiac diseases | 2,355 | 51 (2.2) | 14,652 | 295 (2.0) | ||
| Pulmonary hypertension | 193 | 4 (2.1) | 16,814 | 342 (2.0) | ||
| Cardiovascular conditions | 2,403 | 53 (2.2) | 14,604 | 293 (2.0) | 1.16 (0.84–1.59); P = 0.367 | 1.09 (0.74–1.62); P = 0.658 |
| Physical condition | ||||||
| ASA-PS score of III or higher | 2,445 | 59 (2.4) | 14,562 | 287 (2.0) | ||
| Decreased muscle strength | 200 | 3 (1.5) | 16,807 | 343 (2.0) | ||
| Preterm birth | 2,448 | 68 (2.8) | 14,559 | 278 (1.9) | ||
| Low birth weight | 2,222 | 60 (2.7) | 14,785 | 286 (1.9) | ||
| Physical condition | 4,368 | 107 (2.5) | 12,639 | 239 (1.9) | 1.27 (0.99–1.62); P = 0.058 | 1.11 (0.84–1.48); P = 0.467 |
| Chromosomal abnormality∥ | ||||||
| Trisomy 21 vs. none | 327 | 5 (1.5) | 16,320 | 328 (2.0) | ||
| Trisomy 13 vs. none | 16 | 1 (6.3) | 16,320 | 328 (2.0) | ||
| Trisomy 18 vs. none | 20 | 2 (10.0) | 16,320 | 328 (2.0) | ||
| Other abnormalities vs. none | 314 | 10 (3.2) | 16,320 | 328 (2.0) | 1.64 (0.82–3.28); P = 0.160 | |
| Gastrointestinal condition | ||||||
| Noncompliance to nil per os | 291 | 11 (3.8) | 16,716 | 335 (2.0) | ||
| Full-stomach pathophysiology# | 379 | 16 (4.2) | 16,626 | 330 (2.0) | ||
| Nausea or vomiting | 132 | 6 (4.6) | 16,875 | 340 (2.0) | ||
| Gastrointestinal condition | 604 | 25 (4.1) | 16,403 | 321 (2.0) | 2.28 (1.44–3.63); P < 0.001 | 1.73 (0.97–3.07); P = 0.061 |
| Type of surgery | ||||||
| Cerebral | 636 | 13 (2.0) | 16,371 | 333 (2.0) | ||
| Cardiac surgery | 705 | 13 (1.8) | 16,302 | 333 (2.0) | 0.93 (0.51–1.67); P = 0.796 | 0.70 (0.36–1.36); P = 0.296 |
| Craniocervical | 5,803 | 138 (2.4) | 11,204 | 208 (1.9) | 1.24 (0.98–1.56); P = 0.074 | 1.41 (1.09–1.83); P = 0.009 |
| Emergency surgery | 1,076 | 36 (3.4) | 15,931 | 310 (2.0) | 1.77 (1.21–2.58); P = 0.003 | 1.47 (0.91–2.38); P = 0.116 |
| Difficult airway evaluation | ||||||
| Syndrome assuming difficult airway | 359 | 25 (7.0) | 16,648 | 321 (1.9) | 3.98 (2.41–6.6); P < 0.001 | |
| Difficult mask ventilation** | 152 | 25 (16.5) | 16,555 | 314 (1.9) | 9.7 (5.6–17.1); P < 0.001 | |
| Preoperative difficult airway evaluation | ||||||
| History of difficult airway | 145 | 8 (5.5) | 16,862 | 338 (2.0) | 3.17 (1.41–7.1); P = 0.005 | |
| Anatomical features of difficult airway | ||||||
| Limited cervical range of motion | 70 | 1 (1.4) | 16,937 | 345 (2.0) | 0.64 (0.081–5.0); P = 0.669 | |
| Limited mouth opening | 78 | 6 (7.7) | 16,929 | 340 (2.0) | 4.3 (1.66–11.4); P = 0.003 | |
| Short hyomental distance | 27 | 2 (7.4) | 16,980 | 344 (2.0) | 3.60 (0.70–18.7); P = 0.127 | |
| Upper airway obstruction | 122 | 5 (4.1) | 16,885 | 341 (2.0) | 2.01 (0.75–5.4); P = 0.167 | |
| Midface hypoplasia | 74 | 1 (1.4) | 16,933 | 345 (2.0) | 0.58 (0.075–4.5); P = 0.604 | |
| Macroglossia | 87 | 3 (3.5) | 16,920 | 343 (2.0) | 1.75 (0.50–6.1); P = 0.380 | |
| Micrognacia | 348 | 21 (6.0) | 16,659 | 325 (2.0) | 3.39 (2.00–5.7); P < 0.001 | |
| Macrocephaly | 47 | 1 (2.1) | 16,960 | 345 (2.0) | 1.09 (0.14–8.8); P = 0.932 | |
| Preoperative difficult airway features | ||||||
| One feature vs. none | 530 | 20 (3.8) | 16,336 | 317 (1.9) | 2.00 (1.20–3.32); P = 0.007 | 1.74 (1.02–2.95); P = 0.042 |
| Two or more features vs. none | 141 | 9 (6.4) | 16,336 | 317 (1.9) | 3.49 (1.59–7.7); P = 0.002 | 2.82 (1.21–6.6); P = 0.017 |
| Airway management | ||||||
| Attempt frequency (three times or more) | 487 | 68 (14.0) | 16,520 | 278 (1.7) | 13.3 (8.3–21.5); P < 0.001 | |
| Reason for initiating a course | ||||||
| Airway issue vs. planned | 157 | 33 (21.0) | 16,850 | 313 (1.9) | ||
| Least experienced provider in each course | ||||||
| Frequent or occasional vs. specialist | 2,199 | 45 (2.1) | 3,434 | 92 (2.7) | 0.82 (0.53–1.26); P = 0.363 | 0.88 (0.57–1.37); P = 0.575 |
| Trainee vs. specialist | 10,158 | 180 (1.8) | 3,434 | 92 (2.7) | 0.77 (0.57–1.04); P = 0.086 | 0.80 (0.59–1.09); P = 0.159 |
| Airway devices at first attempt | ||||||
| Uncuffed ETT vs. cuffed ETT | 965 | 21 (2.2) | 11,502 | 262 (2.3) | ||
| SGD placement vs. direct laryngoscopy†† | 4,762 | 63 (1.3) | 12,118 | 280 (2.3) | 0.46 (0.340–0.62); P < 0.001 | 0.42 (0.288–0.62); P < 0.001 |
| Video laryngoscopy vs. direct laryngoscopy | 2,015 | 67 (3.3) | 9,978 | 219 (2.2) | 1.82 (1.32–2.50); P < 0.001 | 0.70 (0.45–1.08); P = 0.109 |
| Supportive maneuvers at first attempt | ||||||
| Cricoid pressure | 399 | 17 (4.3) | 16,608 | 329 (2.0) | ||
| External laryngeal manipulation | 2,107 | 76 (3.6) | 14,900 | 270 (1.8) | 2.22 (1.66–2.96); P < 0.001 | 1.90 (1.41–2.56); P < 0.001 |
| Apneic oxygenation | 191 | 9 (4.7) | 16,816 | 337 (2.0) | ||
| Anesthesia management | ||||||
| Induction method | ||||||
| Intravenous vs. inhalational | 5,921 | 118 (2.0) | 11,067 | 223 (2.0) | 0.92 (0.73–1.18); P = 0.526 | 1.05 (0.78–1.41); P = 0.749 |
| Rapid sequence | 246 | 8 (3.3) | 16,761 | 338 (2.0) | 1.65 (0.76–3.59); P = 0.204 | 0.88 (0.36–2.15); P = 0.781 |
| Muscle relaxant use at first attempt | 12,481 | 240 (1.9) | 4,526 | 106 (2.3) | 1.02 (0.78–1.34); P = 0.890 | 0.62 (0.43–0.89); P = 0.009 |
| Premedication | 5,324 | 118 (2.2) | 11,683 | 228 (2.0) | ||
The data are described as numbers (%), means ± SDs, or medians (IQRs). The mean ± SD or median (IQR) values are shown in continuous variables (age and weight) by the presence (yes) and absence (no) of adverse events. The number (%) shows the occurrence of adverse events in nominal variables (sex [male vs. female], place for airway management (mixed adult–pediatric hospital vs. pediatric hospital; catheter laboratory vs. operating room; CT, MRI, or radiation therapy room vs. operating room), perioperative difficult airway features, reasons for initiating a course, least experienced provider in each course, airway devices at first attempt, and induction method). The multivariable regression analysis included the variables reported in the multivariable analysis columns. The maximal value of variance inflation factor of incorporated variables in the multilevel logistic regression model was 1.45.
Median body weight included one missing value.
Catheter laboratory vs. operating room included three missing values.
CT, MRI, radiation therapy rooms vs. operating room included three missing values.
Hypoxemia was defined as a peripheral arterial oxygen saturation of 94% or lower on room air.
Chromosomal abnormality included 10 missing values.
Full-stomach pathophysiology included two missing values.
Difficult mask ventilation included three missing values.
SGD placement vs. direct laryngoscopy included seven missing values.
ASA-PS, American Society of Anesthesiologists Physical Status; CT, computed tomography; ETT, endotracheal tube; IQR, interquartile range; MRI, magnetic resonance imaging; OR, odds ratio; SGD, supra glottic device; URI, upper respiratory infection.