Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Epidemiology and incidence of severe respiratory critical events in ear, nose and throat surgery in children in Europe

A prospective multicentre observational study

Virag, Katalin; Sabourdin, Nada; Thomas, Mark; Veyckemans, Francis; Habre, Walid For the APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

European Journal of Anaesthesiology (EJA): March 2019 - Volume 36 - Issue 3 - p 185–193
doi: 10.1097/EJA.0000000000000951
Paediatric anaesthesia

BACKGROUND Ear, nose and throat (ENT) surgery, the most frequently performed surgical procedure in children, is a strong predictor for peri-operative respiratory complications. However, there is no clear information about peri-operative respiratory severe critical events (SCEs) associated with anaesthesia management of ENT children in Europe.

OBJECTIVE To characterise the epidemiology and incidence of respiratory SCEs during and following ENT surgery in Europe and to identify the risk factors for their occurrence.

DESIGN A secondary analysis of the Anaesthesia PRactice In Children Observational Trial, a prospective observational multicentre cohort trial.

SETTING The study included 261 centres across 33 European countries and took place over a consecutive 2-week recruitment period between April 2014 and January 2015.

PATIENTS We extracted data from 5592 ENT surgical procedures that were performed on 5572 children aged 6.0 (3.6) years (mean (SD)) from the surgical database and compared these with data from 15 952 non-ENT surgical children aged 6.7 (4.8) years.

MAIN OUTCOME MEASURES The primary outcome was the incidence of respiratory SCEs (laryngospasm, bronchospasm and new onset of postoperative stridor). Secondary outcomes were the differences in epidemiology between ENT children and non-ENT surgical children and the risk factors for the occurrence of respiratory SCEs.

RESULTS The incidence (95% confidence interval) of any respiratory SCE (laryngospasm, bronchospasm and postoperative stridor) was 3.93% (3.46 to 4.48) and was significantly higher than that observed in non-ENT surgical children [2.61% (2.37 to 2.87)], with a relative risk of 1.51 (1.28 to 1.77), P less than 0.0001. Younger age (14% decrease in critical events by increasing year, P < 0.0001), history of snoring, recent upper respiratory tract infection and recent wheezing increased the risk of suffering a SCE by over two-fold (P < 0.0001). There was also some evidence for a positive association with age below 4.6 years and lower surgical volume thresholds (<20 cases/2 weeks).

CONCLUSION The results of this study provide additional evidence for strong associations between risk factors and respiratory SCEs in children having ENT surgery. These observations may facilitate the implementation of good clinical practice recommendations for ENT patients in Europe.


From the Bolyai Institute, University of Szeged, Szeged, Hungary (KV), Département d’Anesthésie-Réanimation, Hôpital Armand Trousseau, Hôpitaux Universitaires Paris Est, Assistance Publique Hôpitaux de Paris, Paris, France (NS), Department of Anaesthesia, Great Ormond Street Hospital, London, UK (MT), Département d’Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France (FV) and Department of Anaesthesia, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland (WH)

Correspondence to Walid Habre, MD, PhD, Anaesthesiological Investigations Unit, University Hospitals of Geneva, 6, Rue Willy Donzé, 1205 Geneva, Switzerland Tel: +41 22 37 27 504; fax: +41 22 37 25 485; e-mail:

Published online 10 January 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2019 European Society of Anaesthesiology