Postoperative Respiratory Events and Risk Factors After Hip Reconstruction in Children With Neurological Complex Chronic Conditions

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Abstract
Background: Children with neurological complex chronic conditions (NCCCs) frequently undergo hip reconstruction for hip displacement. Impaired airway clearance and respiratory muscle weakness may increase the risk of postoperative respiratory events. This study evaluated the incidence and predictors of postoperative respiratory events in this population. Methods: We retrospectively reviewed children with NCCCs who underwent hip reconstruction between 2015 and 2024. Baseline characteristics included age, sex, diagnosis, comorbidities, feeding method, ambulatory status, and respiratory support. Operative and anesthesia‐related variables included the number of osteotomies, operative duration and scheduling, estimated blood loss, airway device, and arterial blood gas measurements. The primary outcome was postoperative desaturation (SpO 2 < 95%) requiring supplemental oxygen. Secondary outcomes included pulmonary complications and intensive care unit (ICU) utilization. Predictors were initially evaluated using an expanded multivariable logistic regression model, followed by a reduced model using Firth's penalized logistic regression. Results: Among 126 children (mean age, 7.7 ± 4.1 years), postoperative desaturation occurred in 30 (23.8%). Pulmonary complications included respiratory failure ( n = 6), atelectasis ( n = 5), pulmonary edema ( n = 3), and pneumonia ( n = 1). ICU care was required for 22 children (17.5%). Predictors of postoperative desaturation included congenital brain malformation (adjusted odds ratio [aOR], 21.76; 95% confidence interval [CI], 3.33–249.48), surgery performed on Friday (aOR, 3.35; 95% CI, 1.11–10.24), ≥ 3 osteotomies (aOR, 7.82; 95% CI, 1.83–36.36), and elevated intraoperative bicarbonate (HCO 3 − > 26 mEq/L; aOR, 6.49; 95% CI, 2.36–19.14). Conclusion: Postoperative desaturation was common after hip reconstruction in children with NCCCs, with a subset developing pulmonary complications or requiring ICU care. Identification of perioperative risk factors may improve risk stratification and support targeted respiratory monitoring and preventive strategies in this high‐risk population. Level of Evidence: Level III, retrospective cohort study.

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