Postoperative Respiratory Failure in US Pediatric Care: Evidence from a Nationally Representative Database
Abstract
1. Introduction
- Are specific hospital characteristics (region, teaching status, rurality, ownership, size) associated with the likelihood of pediatric PORF?
- Are specific patient characteristics (age, gender, payer, race/ethnicity, service line of care, or major surgical procedure) associated with PORF?
2. Materials and Methods
2.1. PICO Framework
- Population: Pediatric inpatients aged 0–20 years included in the 2019 HCUP KID database.
- Intervention/Exposure: Patient and hospital characteristics (e.g., region, teaching status, payer, service line, prior major surgery).
- Comparison: Groups stratified by hospital features (e.g., public vs. private, rural vs. urban) and patient factors (e.g., male vs. female, different service lines).
- Outcome: Occurrence of postoperative respiratory failure, defined by AHRQ’s PDI 09 measure.
2.2. Variables
- Hospital characteristics: region (Northeast, Midwest, South, West), location and teaching status (rural, urban non-teaching, urban teaching), bed size (small, medium, large), and ownership (public, private non-profit, private for-profit).
- Patient demographics: age, sex (male = 0, female = 1), race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander, Native American, Other), payer type (government, private, self-pay), and surgical procedure (Yes/No).
2.3. Statistical Analysis
2.4. Ethical Review
3. Results
Multivariate Analysis
4. Discussion
5. Public Health Implications and Recommendations
6. Strengths and Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AHRQ | Agency for Healthcare Research and Quality |
HCUP | Healthcare Cost and Utilization Project |
UPI | unplanned endotracheal tube intubation |
KID | Kids’ Inpatient Databases |
PDI09 | Postoperative Respiratory Failure indicator |
PDI | Pediatric Quality Indicator |
PCLASS_ORPROC | Procedure Classes Refined for ICD-10-PCS |
PORF | Post Operative Respiratory Failure |
MDCs | Major Diagnostic Categories |
DRG | Diagnosis-Related Group |
QI | Quality Improvement |
ICD | International Classification of Diseases |
Appendix A. Classification of Major Operating Room Procedures (PCLASS_ORPROC)
Appendix A.1. The Data Element PCLASS_ORPROC Indicates Whether a Major Operating Room Procedure Was Reported on the Discharge Record [10]
- Minor Diagnostic: Non-operating-room procedures that are diagnostic (e.g., BW2800Z CT scan of head using high osmolar contrast);
- Minor Therapeutic—Non-operating-room procedures that are therapeutic (e.g., 079030Z drainage of head lymph, percutaneous approach);
- Major Diagnostic—All procedures considered valid operating room procedures by the Diagnosis-Related Group (DRG) grouper and that are performed for diagnostic reasons (e.g., 00B00ZX excision of brain, open approach, diagnostic);
- Major Therapeutic—All procedures considered valid operating room procedures by the Diagnosis-Related Group (DRG) grouper and that are performed for therapeutic reasons (e.g., 021008W bypass coronary artery, one artery from aorta with zooplastic tissue, open approach).
Variable | Description | Value | Value Description |
PCLASS_ORPROC | Major operating room ICD-10-PCS procedure indicator | 0 | No major operating room procedure reported on discharge record |
1 | Major operating room procedure reported on discharge record |
- A.
- All discharges were categorized into five hospitalization types (i.e., service lines) in the following hierarchical order: Maternal/Neonatal, Mental health/Substance abuse, Injury, Surgical, and Medical. The criteria for identifying the hospitalization types varies across data years.
Appendix A.2. Beginning in Data Year 2019
- MDC 14 Pregnancy, Childbirth, and Puerperium;
- MDC 15 Newborn and Other Neonates (Perinatal Period).
- MDC 19 Mental Diseases and Disorders;
- MDC 20 Alcohol/Drug Use or Induced Mental Disorders.
- Clinical Classification Software-Refined categories for the principal ICD-10-CM diagnosis:
- ○
- INJ001–INJ027;
- ○
- INJ032.
References
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Variable | Attributes | Frequency | Percent |
---|---|---|---|
PORF (PDI 09) | Absent | 4,214,198 | 92.31% |
Present | 351,201 | 7.69% | |
Hospital bed size | Small | 470,770 | 15.20% |
Medium | 742,057 | 24.00% | |
Large | 1,876,456 | 60.70% | |
Hospital location | Rural | 189,298 | 6.10% |
Urban nonteaching | 356,963 | 11.60% | |
Urban teaching | 2,543,022 | 82.30% | |
Hospital region | Northeast | 529,073 | 17.10% |
Midwest | 696,645 | 22.60% | |
South | 1,183,705 | 38.30% | |
West | 679,860 | 22.00% | |
Hospital ownership | Public | 365,784 | 11.80% |
Private, not for profit | 2,382,758 | 77.10% | |
Private, investor owned | 340,741 | 11.00% | |
Gender | Female | 1,587,394 | 51.40% |
Male | 1,500,745 | 48.60% | |
Race | White | 1,407,652 | 45.60% |
Black | 513,619 | 16.60% | |
Hispanic | 607,329 | 19.70% | |
Asian/Pacific Islander | 123,698 | 4.00% | |
Native American | 26,306 | 0.90% | |
Other | 188,042 | 6.10% | |
Service line | Maternal and Neonatal | 1,716,825 | 55.60% |
Mental health/substance use | 209,939 | 6.80% | |
Injury | 97,434 | 3.20% | |
Surgical | 219,576 | 7.10% | |
Medical | 845,509 | 27.40% | |
Payment source | Medicare | 10,554 | 0.30% |
Medicaid | 1,567,452 | 50.70% | |
Private insurance | 1,270,547 | 41.10% | |
Self-pay | 131,918 | 4.30% | |
No charge | 3,843 | 0.10% | |
Other | 100,660 | 3.30% | |
Operation on record | No operation in record | 2,718,390 | 88.00% |
Major operating on record | 370,893 | 12.00% | |
Variable | Attributes | Mean | Std Dev |
Age | N = 4,571,036 | 5.76 | 7.82 |
Variable | Estimate | SE | Wald Test | p-Value | Adjusted OR | Wald 95% CI for AOR Lower Upper | ||
---|---|---|---|---|---|---|---|---|
Intercept | −1.7917 | 0.0124 | 20,964.6656 | <0.0001 | 0.167 | - | - | |
AGE | −0.00418 | 0.000298 | 196.0796 | <0.0001 | 0.996 | 0.995 | 0.996 | |
SEX | Female | 0.00150 | 0.00379 | 0.1571 | 0.6919 | 1.002 | 0.994 | 1.009 |
Male * | ||||||||
RACE | White | |||||||
Black | 0.000486 | 0.00536 | 0.0082 | 0.9278 | 1.000 | 0.990 | 1.011 | |
Hispanic | −0.0850 | 0.00521 | 266.0689 | <0.0001 | 0.918 | 0.909 | 0.928 | |
Asian/Pacific Islander | 0.0226 | 0.00914 | 6.1137 | 0.0134 | 1.023 | 1.005 | 1.041 | |
Native American | 0.0508 | 0.0177 | 8.1824 | 0.0042 | 1.052 | 1.016 | 1.089 | |
Others * | 0.00803 | 0.00789 | 1.0349 | 0.3090 | 1.008 | 0.993 | 1.024 | |
Service line | Maternal and Neonatal | −0.5617 | 0.00471 | 14,217.7550 | <0.0001 | 0.570 | 0.565 | 0.576 |
Mental health/substance use | −0.3991 | 0.00884 | 2040.6849 | <0.0001 | 0.671 | 0.659 | 0.683 | |
Injury | 0.0112 | 0.0102 | 1.2020 | 0.2729 | 1.011 | 0.991 | 1.032 | |
Surgical | 0.4124 | 0.0111 | 1385.5081 | <0.0001 | 1.510 | 1.478 | 1.544 | |
Medical * | ||||||||
Payment Source | Medicare | −0.0385 | 0.0329 | 1.3729 | 0.2413 | 0.962 | 0.902 | 1.026 |
Medicaid | −0.0589 | 0.00927 | 40.3335 | <0.0001 | 0.943 | 0.926 | 0.960 | |
Private insurance | 0.0533 | 0.00937 | 32.3885 | <0.0001 | 1.055 | 1.036 | 1.074 | |
No charge | −0.0325 | 0.0492 | 0.4366 | 0.5088 | 0.968 | 0.879 | 1.066 | |
Other | 0.0759 | 0.0130 | 33.9742 | <0.0001 | 1.079 | 1.052 | 1.107 | |
Self-pay * | ||||||||
Operation on record | Major operating room procedure on record | 0.1643 | 0.00953 | 297.2510 | <0.0001 | 1.179 | 1.157 | 1.201 |
Hospital bed size | Small | −0.2887 | 0.00501 | 3321.6974 | <0.0001 | 0.749 | 0.742 | 0.757 |
Medium | −0.3458 | 0.00470 | 5408.6080 | <0.0001 | 0.708 | 0.701 | 0.714 | |
Large * | ||||||||
Hospital location | Rural | −1.1499 | 0.00777 | 21,923.3961 | <0.0001 | 0.317 | 0.312 | 0.322 |
Urban nonteaching | −0.9302 | 0.00692 | 18,057.0116 | <0.0001 | 0.394 | 0.389 | 0.400 | |
Urban teaching * | ||||||||
Hospital region | Northeast | −0.2290 | 0.00603 | 1443.3234 | <0.0001 | 0.795 | 0.786 | 0.805 |
Midwest | −0.1925 | 0.00570 | 1138.1736 | <0.0001 | 0.825 | 0.816 | 0.834 | |
South | −0.1477 | 0.00499 | 875.6528 | <0.0001 | 0.863 | 0.854 | 0.871 | |
West * | ||||||||
Hospital ownership | Public | 0.1361 | 0.00784 | 301.7575 | <0.0001 | 1.146 | 1.128 | 1.164 |
Private, not-profit | 0.1328 | 0.00637 | 435.0090 | <0.0001 | 1.142 | 1.128 | 1.156 | |
Private, investor-owned * |
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Samawi, M.; Shah, G.H.; Kimsey, L. Postoperative Respiratory Failure in US Pediatric Care: Evidence from a Nationally Representative Database. Pediatr. Rep. 2025, 17, 58. https://doi.org/10.3390/pediatric17030058
Samawi M, Shah GH, Kimsey L. Postoperative Respiratory Failure in US Pediatric Care: Evidence from a Nationally Representative Database. Pediatric Reports. 2025; 17(3):58. https://doi.org/10.3390/pediatric17030058
Chicago/Turabian StyleSamawi, Michael, Gulzar H. Shah, and Linda Kimsey. 2025. "Postoperative Respiratory Failure in US Pediatric Care: Evidence from a Nationally Representative Database" Pediatric Reports 17, no. 3: 58. https://doi.org/10.3390/pediatric17030058
APA StyleSamawi, M., Shah, G. H., & Kimsey, L. (2025). Postoperative Respiratory Failure in US Pediatric Care: Evidence from a Nationally Representative Database. Pediatric Reports, 17(3), 58. https://doi.org/10.3390/pediatric17030058